Dural Sinus Angioplasty
The dural sinuses are large venous structures responsible for draining blood from the brain. Situations that cause a narrowing of the dural sinuses (stenosis) can lead to difficulty in cerebral venous drainage and consequent intracranial hypertension.
The procedure is performed in hemodynamics and consists of placing a stent in the region of the stenosis to restore the normal caliber of the dural sinus and normalize cerebral venous drainage.
Idiopathic intracranial hypertension is more common in young, obese women. The main symptoms are:
- Headache;
- Visual alteration (double vision, visual clouding and visual field changes);
- Look away (strabismus);
- Papilledema (optic nerve edema – indicative of intracranial hypertension);
- Pulsatile tinnitus.
Dural sinus angioplasty is indicated in cases of severe stenosis of these structures associated with intracranial hypertension that is refractory to clinical treatment, especially in cases of visual deficit and persistent headache.
Dural sinus angioplasty is a minimally invasive technique where it is not necessary to open the patient’s skull to treat the lesion. The surgery is performed endovascularly, that is, inside the arteries. To do this, it is necessary to perform a puncture of an artery in the patient’s leg, at the level of the groin (femoral artery) or in the arm (radial or brachial artery) and take a catheter to the cervical vessels to perform a cerebral angiography that will confirm the presence of dural sinus stenosis.
Because it is a venous disease, it is necessary to perform a puncture of the femoral vein (in the leg) or jugular vein (neck) and take a microcatheter to the region of narrowing (stenosis). This microcatheter will perform a measurement of intracranial pressure. Once the elevation of pressure within the skull is confirmed and a satisfactory pressure difference is evidenced before and after the stenosis, the placement of a stent is indicated, which will correct this narrowing and restore the usual cerebral venous drainage.
There are several types of stents that are able to treat dural sinus stenosis. The choice of the most suitable material will depend on the characteristics of the lesion and the patient, therefore, the choice of the best technique is individualized.
No surgical incision is needed, just a small hole in the skin that doesn’t need special dressings.
What are dural venous sinuses?
The dural venous sinuses (also called dural sinuses, brain sinuses, or cranial sinuses) are large venous channels found between the layers of dura mater in the brain.
They receive blood from the internal and external veins of the brain, receive cerebrospinal fluid (cerebrospinal fluid) from the subarachnoid space, and finally drain into the jugular veins that will carry the blood back to the heart.
What type of anesthesia is needed for carotid angioplasty?
Diagnostic cerebral angiography, which will confirm the presence of stenosis (narrowing) of the dural sinuses, and intracranial pressure measurement is performed under sedation.
Stent placement to correct the narrowing is done under general anesthesia.
Are there any risks related to the procedure?
Every medical procedure has some risks. However, in general, the interventional methods are those with the lowest rates of complications.
Of the possible risks, the main ones are observed at the puncture site in the groin or wrist, such as a hematoma.
More serious complications such as cerebral ischemia and cerebral hemorrhage can occur, but they are very rare events.
