Venous manometry triage in refractory idiopathic intracranial hypertension: imaging and criteria validity.
Publication/Presentation Date
12-3-2025
Abstract
BACKGROUND AND OBJECTIVE: Venous manometry (VM) is the reference standard for confirming hemodynamically significant transverse sinus stenosis (TSS) in idiopathic intracranial hypertension (IIH). However, no standardized approach exists for triaging refractory IIH (rIIH) patients for VM, and current IIH diagnostic criteria were not designed for this purpose. We evaluated the performance of established IIH diagnostic frameworks and imaging markers in detecting VM-confirmed TSS (vTSS).
METHODS: We retrospectively reviewed consecutive rIIH patients undergoing VM at a tertiary center (2022-2023). vTSS was defined as a trans-stenotic pressure gradient ≥8 mm Hg. Four IIH frameworks (Friedman 2013, modified Dandy 2014, Korsbæk 2023, and a modified 2023 schema), and predefined vascular and non-vascular MRI/MR venography signs were compared against vTSS.
RESULTS: Among 48 rIIH patients (mean age 38.9±9.9 years; all female; body mass index 36.8±9.1 kg/m²), vTSS was present in 33/48 (68.8%). Sensitivity/specificity for vTSS were: Friedman 2013 (78.6%/53.8%), modified Dandy 2014 (83.3%/60.0%), Korsbaek 2023 (90.6%/35.7%), and modified 2023 (93.5%/35.7%). Vascular imaging signs were highly sensitive (96.3%) across definitions; the modified 2023 vascular criteria achieved the highest specificity (42.9%). Five (15.2%) vTSS patients lacked papilledema.
CONCLUSION: Current IIH frameworks vary in accuracy for detecting vTSS. 2023-based criteria maximize sensitivity for vTSS, while modified Dandy 2014 criteria offer greater specificity. Vascular imaging signs outperform non-vascular signs. These findings support incorporating standardized imaging protocols and refined triage algorithms to optimize VM referral in rIIH.
ISSN
1759-8486
Published In/Presented At
Yuan, H., Nisar, A., Sharan, I., Arunkumar, N., Chan, J., Qiu, E., Mondel, P., Jain, N., Talekar, K., Chaganti, J., Faro, S., Jabbour, P., Tjoumakaris, S. I., Evans, J. J., Shah, S. O., Beier, D., Jensen, R., Moster, M., Spare, N., Marmura, M., … Gooch, M. R. (2025). Venous manometry triage in refractory idiopathic intracranial hypertension: imaging and criteria validity. Journal of neurointerventional surgery, jnis-2025-024469. Advance online publication. https://doi.org/10.1136/jnis-2025-024469
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
41339077
Department(s)
Administration and Leadership
Document Type
Article