C112 Transverse sinus stenting in a pediatric patient with orbital meningocele secondary to refractory intracranial hypertension: the role of endovascular treatment

<h3>Introduction</h3> In pediatric patients, intracranial hypertension (ICH) can manifest through atypical compensatory mechanisms due to increased cranial compliance and cerebrospinal fluid (CSF) dynamics. Orbital meningoceles and external hydrocephalus, though rare, may indicate chronic intracranial pressure overload. We report the case of a 6-year-old child with orbital meningocele secondary to otogenic cerebral venous thrombosis, treated successfully with endovascular sinus stenting. <h3>Case Description</h3> A 6-year-old boy presented with acute otomastoiditis complicated by thrombosis of the right sigmoid and transverse sinuses extending to the internal jugular vein. Despite antibiotics and mastoidectomy, he developed progressive ICH signs, including papilledema and sixth nerve palsy. MRI/MRV showed venous outflow impairment and a left orbital meningocele (22 × 14 mm) herniating through the superior orbital fissure, along with mild external hydrocephalus. Given clinical worsening and lack of response to conservative treatment, he underwent endovascular thrombectomy and right transverse sinus stenting. The procedure promptly improved venous drainage, with rapid clinical recovery, resolution of papilledema, and significant meningocele reduction on follow-up imaging. <h3>Conclusions</h3> This case highlights the unique compensatory responses of the pediatric brain to venous outflow obstruction, including orbital meningocele. Although rare, such findings should be considered markers of sustained ICH. Transverse sinus stenting may be a valuable therapeutic option in selected pediatric cases. Early diagnosis and multidisciplinary intervention are crucial to avoid irreversible complications. Further studies are needed to define optimal treatment timing in children with cerebral venous sinus thrombosis. <h3>Conflict of Interest</h3> No