{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T15:29:21Z","timestamp":1772724561967,"version":"3.50.1"},"reference-count":36,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,8,1]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Growing evidence suggests that venous outflow obstruction from venous sinus stenosis (VSS) may lead to increased intracranial pressure (ICP) in patients with idiopathic intracranial hypertension (IIH). There is a paucity of evidence examining clinical predictors of elevated cerebral venous pressure gradient (CVPG) from VSS in patients with IIH. In this study, the authors examined predictors of elevated CVPG, determined the sensitivity and specificity of common presenting symptoms of IIH, and identified the optimal opening pressure threshold on lumbar puncture (LP) to determine which patients should undergo venous manometry (VM).<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n Patient demographics, presenting symptoms, complications, and opening pressure on LP were collected. Venous pressure gradient across a stenotic dural venous sinus and maximum venous pressure values were recorded from cerebral venograms. VM was considered positive when the CVPG was \u2265 8 mm Hg between two contiguous segments of a dural venous sinus. Sensitivity, specificity, and multivariable logistic regression analysis was performed.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n \n The predominant patient population was young (mean age 38.9 years), obese (BMI \u2265 30; 83.8%), and female (95.0%). Sensitivity and specificity for papilledema were 74% and 70% (area under the curve [AUC] 0.71, 95% CI 0.63\u20130.80), and 70% and 63% (AUC 0.66, 95% CI 0.57\u20130.75) for pulsatile tinnitus. Vision changes demonstrated a sensitivity of 80% and specificity of 50% (AUC 0.63, 95% CI 0.54\u20130.72). VSS seen on magnetic resonance venography (MRV) demonstrated a sensitivity of 90% and specificity of 53% (AUC 0.71, 95% CI 0.63\u20130.79). Youden\u2019s index analysis identified an opening pressure \u2265 25 cm H\n 2<\/jats:sub>\n O on LP (AUC 0.72, 95% CI 0.60\u20130.83) as an optimal threshold for predicting elevated CVPG.\n <\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n \n Predictors of elevated CVPG on VM include childbearing age, African American race, papilledema, pulsatile tinnitus, obesity (BMI \u2265 30), focal VSS with unilateral dominance in venous drainage seen on MRV, or an opening pressure on LP \u2265 25 cm H\n 2<\/jats:sub>\n O.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2024.10.jns241749","type":"journal-article","created":{"date-parts":[[2025,3,7]],"date-time":"2025-03-07T20:52:57Z","timestamp":1741380777000},"page":"543-549","source":"Crossref","is-referenced-by-count":0,"title":["Predictors of dural venous sinus pressure gradient in patients with idiopathic intracranial hypertension"],"prefix":"10.3171","volume":"143","author":[{"given":"Arbaz A.","family":"Momin","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Basel","family":"Musmar","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kareem","family":"El Naamani","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nikolaos","family":"Mouchtouris","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dwight Mitchell","family":"Self","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthews","family":"Lan","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keenan","family":"Piper","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Caitlin","family":"Ritz","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stavropoula I.","family":"Tjoumakaris","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pascal M.","family":"Jabbour","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M. Reid","family":"Gooch","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"1","key":"b1","series-title":"Lancet Neurol","first-page":"78","article-title":"Understanding idiopathic intracranial hypertension: mechanisms, management, and future directions","volume":"15","author":"Markey KA","year":"2016","unstructured":"Markey KA, Mollan SP, Jensen RH, Sinclair AJ. Understanding idiopathic intracranial hypertension: mechanisms, management, and future directions. Lancet Neurol. 2016;15(1):78\u201391."},{"issue":"16","key":"b2","series-title":"Cephalalgia","first-page":"1627","article-title":"Is cerebrospinal fluid shunting in idiopathic intracranial hypertension worthwhile? A 10-year review","volume":"31","author":"Sinclair AJ","year":"2011","unstructured":"Sinclair AJ, Kuruvath S, Sen D, Nightingale PG, Burdon MA, Flint G. Is cerebrospinal fluid shunting in idiopathic intracranial hypertension worthwhile? A 10-year review. Cephalalgia. 2011;31(16):1627\u20131633."},{"issue":"2","key":"b3","series-title":"J Neuroophthalmol","first-page":"113","article-title":"Venous sinus stenting in idiopathic intracranial hypertension: results of a prospective trial","volume":"37","author":"Dinkin MJ","year":"2017","unstructured":"Dinkin MJ, Patsalides A. Venous sinus stenting in idiopathic intracranial hypertension: results of a prospective trial. J Neuroophthalmol. 2017;37(2):113\u2013121."},{"issue":"6","key":"b4","series-title":"Oper Neurosurg (Hagerstown)","first-page":"e338","article-title":"Transverse sinus stenting for the treatment of idiopathic intracranial hypertension with a pressure gradient of 70 mm Hg: a technical note and systematic review","volume":"25","author":"Ghanem M","year":"2023","unstructured":"Ghanem M, El Naamani K, Rawad A, Transverse sinus stenting for the treatment of idiopathic intracranial hypertension with a pressure gradient of 70 mm Hg: a technical note and systematic review. Oper Neurosurg (Hagerstown). 2023;25(6):e338\u2013e344."},{"issue":"12","key":"b5","series-title":"J Neurol Neurosurg Psychiatry","first-page":"1662","article-title":"Idiopathic intracranial hypertension: 12 cases treated by venous sinus stenting","volume":"74","author":"Higgins JN","year":"2003","unstructured":"Higgins JN, Cousins C, Owler BK, Sarkies N, Pickard JD. Idiopathic intracranial hypertension: 12 cases treated by venous sinus stenting. J Neurol Neurosurg Psychiatry. 2003;74(12):1662\u20131666."},{"issue":"2","key":"b6","series-title":"J Neurointerv Surg","first-page":"175","article-title":"Venous sinus stenting lowers the intracranial pressure in patients with idiopathic intracranial hypertension","volume":"11","author":"Patsalides A","year":"2019","unstructured":"Patsalides A, Oliveira C, Wilcox J, Venous sinus stenting lowers the intracranial pressure in patients with idiopathic intracranial hypertension. J Neurointerv Surg. 2019;11(2):175\u2013178."},{"issue":"2","key":"b7","series-title":"J Neurosurg","first-page":"347","article-title":"Incidence and predictors of dural venous sinus pressure gradient in idiopathic intracranial hypertension and non-idiopathic intracranial hypertension headache patients: results from 164 cerebral venograms","volume":"126","author":"Levitt MR","year":"2017","unstructured":"Levitt MR, Hlubek RJ, Moon K, Incidence and predictors of dural venous sinus pressure gradient in idiopathic intracranial hypertension and non-idiopathic intracranial hypertension headache patients: results from 164 cerebral venograms. J Neurosurg. 2017;126(2):347\u2013353."},{"issue":"4","key":"b8","series-title":"J Neurointerv Surg","first-page":"380","article-title":"Venous sinus stenting for idiopathic intracranial hypertension: a systematic review and meta-analysis","volume":"11","author":"Nicholson P","year":"2019","unstructured":"Nicholson P, Brinjikji W, Radovanovic I, Venous sinus stenting for idiopathic intracranial hypertension: a systematic review and meta-analysis. J Neurointerv Surg. 2019;11(4):380\u2013385."},{"issue":"5","key":"b9","series-title":"Neurosurgery","first-page":"734","article-title":"Venous sinus stenting for low pressure gradient stenoses in idiopathic intracranial hypertension","volume":"91","author":"Inam ME","year":"2022","unstructured":"Inam ME, Martinez-Gutierrez JC, Kole MJ, Venous sinus stenting for low pressure gradient stenoses in idiopathic intracranial hypertension. Neurosurgery. 2022;91(5):734\u2013740."},{"key":"b10","series-title":"J Neuroophthalmol","article-title":"Clinical characteristics of idiopathic intracranial hypertension in older adults","author":"Sabet SJ","unstructured":"Sabet SJ, Gasquet NC, Henderson AD, Carey AR. Clinical characteristics of idiopathic intracranial hypertension in older adults. J Neuroophthalmol. Published online January 18, 2024. doi:10.1097\/WNO.0000000000002055"},{"issue":"2","key":"b11","series-title":"Headache","first-page":"178","article-title":"The relationship between idiopathic intracranial hypertension and obesity","volume":"49","author":"Hannerz J","year":"2009","unstructured":"Hannerz J, Ericson K. The relationship between idiopathic intracranial hypertension and obesity. Headache. 2009;49(2):178\u2013184."},{"issue":"10","key":"b12","series-title":"Eur J Neurol","first-page":"1266","article-title":"The incidence and prevalence of idiopathic intracranial hypertension in Sheffield, UK","volume":"18","author":"Raoof N","year":"2011","unstructured":"Raoof N, Sharrack B, Pepper IM, Hickman SJ. The incidence and prevalence of idiopathic intracranial hypertension in Sheffield, UK. Eur J Neurol. 2011;18(10):1266\u20131268."},{"key":"b13","series-title":"BMJ","first-page":"c2701","article-title":"Low energy diet and intracranial pressure in women with idiopathic intracranial hypertension: prospective cohort study","volume":"341","author":"Sinclair AJ","year":"2010","unstructured":"Sinclair AJ, Burdon MA, Nightingale PG, Low energy diet and intracranial pressure in women with idiopathic intracranial hypertension: prospective cohort study. BMJ. 2010;341:c2701."},{"issue":"4","key":"b14","series-title":"Neurology","first-page":"1094","article-title":"Effects of weight loss on the course of idiopathic intracranial hypertension in women","volume":"50","author":"Kupersmith MJ","year":"1998","unstructured":"Kupersmith MJ, Gamell L, Turbin R, Peck V, Spiegel P, Wall M. Effects of weight loss on the course of idiopathic intracranial hypertension in women. Neurology. 1998;50(4):1094\u20131098."},{"issue":"9","key":"b15","series-title":"Neurology","first-page":"1418","article-title":"Idiopathic intracranial hypertension: the prevalence and morphology of sinovenous stenosis","volume":"60","author":"Farb RI","year":"2003","unstructured":"Farb RI, Vanek I, Scott JN, Idiopathic intracranial hypertension: the prevalence and morphology of sinovenous stenosis. Neurology. 2003;60(9):1418\u20131424."},{"issue":"2","key":"b16","series-title":"J Neurointerv Surg","first-page":"173","article-title":"A new index for the assessment of transverse sinus stenosis for diagnosing idiopathic intracranial hypertension","volume":"9","author":"Carvalho GB","year":"2017","unstructured":"Carvalho GB, Matas SL, Idagawa MH, A new index for the assessment of transverse sinus stenosis for diagnosing idiopathic intracranial hypertension. J Neurointerv Surg. 2017;9(2):173\u2013177."},{"issue":"3","key":"b17","series-title":"Panminerva Med","first-page":"201","article-title":"The role of dural sinus stenosis in idiopathic intracranial hypertension pathogenesis: the self-limiting venous collapse feedback-loop model","volume":"56","author":"De Simone R","year":"2014","unstructured":"De Simone R, Ranieri A, Montella S, Bilo L, Cautiero F. The role of dural sinus stenosis in idiopathic intracranial hypertension pathogenesis: the self-limiting venous collapse feedback-loop model. Panminerva Med. 2014;56(3):201\u2013209."},{"issue":"5","key":"b18","series-title":"J Neurosurg","first-page":"1126","article-title":"Venous sinus stenting for reduction of intracranial pressure in IIH: a prospective pilot study","volume":"127","author":"Liu KC","year":"2017","unstructured":"Liu KC, Starke RM, Durst CR, Venous sinus stenting for reduction of intracranial pressure in IIH: a prospective pilot study. J Neurosurg. 2017;127(5):1126\u20131133."},{"issue":"1","key":"b1","series-title":"Lancet Neurol","first-page":"78","article-title":"Understanding idiopathic intracranial hypertension: mechanisms, management, and future directions","volume":"15","author":"Markey KA","year":"2016","unstructured":"Markey KA, Mollan SP, Jensen RH, Sinclair AJ. Understanding idiopathic intracranial hypertension: mechanisms, management, and future directions. Lancet Neurol. 2016;15(1):78\u201391."},{"issue":"16","key":"b2","series-title":"Cephalalgia","first-page":"1627","article-title":"Is cerebrospinal fluid shunting in idiopathic intracranial hypertension worthwhile? A 10-year review","volume":"31","author":"Sinclair AJ","year":"2011","unstructured":"Sinclair AJ, Kuruvath S, Sen D, Nightingale PG, Burdon MA, Flint G. Is cerebrospinal fluid shunting in idiopathic intracranial hypertension worthwhile? A 10-year review. Cephalalgia. 2011;31(16):1627\u20131633."},{"issue":"2","key":"b3","series-title":"J Neuroophthalmol","first-page":"113","article-title":"Venous sinus stenting in idiopathic intracranial hypertension: results of a prospective trial","volume":"37","author":"Dinkin MJ","year":"2017","unstructured":"Dinkin MJ, Patsalides A. Venous sinus stenting in idiopathic intracranial hypertension: results of a prospective trial. J Neuroophthalmol. 2017;37(2):113\u2013121."},{"issue":"6","key":"b4","series-title":"Oper Neurosurg (Hagerstown)","first-page":"e338","article-title":"Transverse sinus stenting for the treatment of idiopathic intracranial hypertension with a pressure gradient of 70 mm Hg: a technical note and systematic review","volume":"25","author":"Ghanem M","year":"2023","unstructured":"Ghanem M, El Naamani K, Rawad A, Transverse sinus stenting for the treatment of idiopathic intracranial hypertension with a pressure gradient of 70 mm Hg: a technical note and systematic review. Oper Neurosurg (Hagerstown). 2023;25(6):e338\u2013e344."},{"issue":"12","key":"b5","series-title":"J Neurol Neurosurg Psychiatry","first-page":"1662","article-title":"Idiopathic intracranial hypertension: 12 cases treated by venous sinus stenting","volume":"74","author":"Higgins JN","year":"2003","unstructured":"Higgins JN, Cousins C, Owler BK, Sarkies N, Pickard JD. Idiopathic intracranial hypertension: 12 cases treated by venous sinus stenting. J Neurol Neurosurg Psychiatry. 2003;74(12):1662\u20131666."},{"issue":"2","key":"b6","series-title":"J Neurointerv Surg","first-page":"175","article-title":"Venous sinus stenting lowers the intracranial pressure in patients with idiopathic intracranial hypertension","volume":"11","author":"Patsalides A","year":"2019","unstructured":"Patsalides A, Oliveira C, Wilcox J, Venous sinus stenting lowers the intracranial pressure in patients with idiopathic intracranial hypertension. J Neurointerv Surg. 2019;11(2):175\u2013178."},{"issue":"2","key":"b7","series-title":"J Neurosurg","first-page":"347","article-title":"Incidence and predictors of dural venous sinus pressure gradient in idiopathic intracranial hypertension and non-idiopathic intracranial hypertension headache patients: results from 164 cerebral venograms","volume":"126","author":"Levitt MR","year":"2017","unstructured":"Levitt MR, Hlubek RJ, Moon K, Incidence and predictors of dural venous sinus pressure gradient in idiopathic intracranial hypertension and non-idiopathic intracranial hypertension headache patients: results from 164 cerebral venograms. J Neurosurg. 2017;126(2):347\u2013353."},{"issue":"4","key":"b8","series-title":"J Neurointerv Surg","first-page":"380","article-title":"Venous sinus stenting for idiopathic intracranial hypertension: a systematic review and meta-analysis","volume":"11","author":"Nicholson P","year":"2019","unstructured":"Nicholson P, Brinjikji W, Radovanovic I, Venous sinus stenting for idiopathic intracranial hypertension: a systematic review and meta-analysis. J Neurointerv Surg. 2019;11(4):380\u2013385."},{"issue":"5","key":"b9","series-title":"Neurosurgery","first-page":"734","article-title":"Venous sinus stenting for low pressure gradient stenoses in idiopathic intracranial hypertension","volume":"91","author":"Inam ME","year":"2022","unstructured":"Inam ME, Martinez-Gutierrez JC, Kole MJ, Venous sinus stenting for low pressure gradient stenoses in idiopathic intracranial hypertension. Neurosurgery. 2022;91(5):734\u2013740."},{"key":"b10","series-title":"J Neuroophthalmol","article-title":"Clinical characteristics of idiopathic intracranial hypertension in older adults","author":"Sabet SJ","unstructured":"Sabet SJ, Gasquet NC, Henderson AD, Carey AR. Clinical characteristics of idiopathic intracranial hypertension in older adults. J Neuroophthalmol. Published online January 18, 2024. doi:10.1097\/WNO.0000000000002055"},{"issue":"2","key":"b11","series-title":"Headache","first-page":"178","article-title":"The relationship between idiopathic intracranial hypertension and obesity","volume":"49","author":"Hannerz J","year":"2009","unstructured":"Hannerz J, Ericson K. The relationship between idiopathic intracranial hypertension and obesity. Headache. 2009;49(2):178\u2013184."},{"issue":"10","key":"b12","series-title":"Eur J Neurol","first-page":"1266","article-title":"The incidence and prevalence of idiopathic intracranial hypertension in Sheffield, UK","volume":"18","author":"Raoof N","year":"2011","unstructured":"Raoof N, Sharrack B, Pepper IM, Hickman SJ. The incidence and prevalence of idiopathic intracranial hypertension in Sheffield, UK. Eur J Neurol. 2011;18(10):1266\u20131268."},{"key":"b13","series-title":"BMJ","first-page":"c2701","article-title":"Low energy diet and intracranial pressure in women with idiopathic intracranial hypertension: prospective cohort study","volume":"341","author":"Sinclair AJ","year":"2010","unstructured":"Sinclair AJ, Burdon MA, Nightingale PG, Low energy diet and intracranial pressure in women with idiopathic intracranial hypertension: prospective cohort study. BMJ. 2010;341:c2701."},{"issue":"4","key":"b14","series-title":"Neurology","first-page":"1094","article-title":"Effects of weight loss on the course of idiopathic intracranial hypertension in women","volume":"50","author":"Kupersmith MJ","year":"1998","unstructured":"Kupersmith MJ, Gamell L, Turbin R, Peck V, Spiegel P, Wall M. Effects of weight loss on the course of idiopathic intracranial hypertension in women. Neurology. 1998;50(4):1094\u20131098."},{"issue":"9","key":"b15","series-title":"Neurology","first-page":"1418","article-title":"Idiopathic intracranial hypertension: the prevalence and morphology of sinovenous stenosis","volume":"60","author":"Farb RI","year":"2003","unstructured":"Farb RI, Vanek I, Scott JN, Idiopathic intracranial hypertension: the prevalence and morphology of sinovenous stenosis. Neurology. 2003;60(9):1418\u20131424."},{"issue":"2","key":"b16","series-title":"J Neurointerv Surg","first-page":"173","article-title":"A new index for the assessment of transverse sinus stenosis for diagnosing idiopathic intracranial hypertension","volume":"9","author":"Carvalho GB","year":"2017","unstructured":"Carvalho GB, Matas SL, Idagawa MH, A new index for the assessment of transverse sinus stenosis for diagnosing idiopathic intracranial hypertension. J Neurointerv Surg. 2017;9(2):173\u2013177."},{"issue":"3","key":"b17","series-title":"Panminerva Med","first-page":"201","article-title":"The role of dural sinus stenosis in idiopathic intracranial hypertension pathogenesis: the self-limiting venous collapse feedback-loop model","volume":"56","author":"De Simone R","year":"2014","unstructured":"De Simone R, Ranieri A, Montella S, Bilo L, Cautiero F. The role of dural sinus stenosis in idiopathic intracranial hypertension pathogenesis: the self-limiting venous collapse feedback-loop model. Panminerva Med. 2014;56(3):201\u2013209."},{"issue":"5","key":"b18","series-title":"J Neurosurg","first-page":"1126","article-title":"Venous sinus stenting for reduction of intracranial pressure in IIH: a prospective pilot study","volume":"127","author":"Liu KC","year":"2017","unstructured":"Liu KC, Starke RM, Durst CR, Venous sinus stenting for reduction of intracranial pressure in IIH: a prospective pilot study. 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