Venous sinus stenting for refractory benign intracranial hypertension

Similarities between benign intracranial hypertension and cerebral venous sinus thrombosis are well recognised and the importance of excluding the latter—especially sagittal sinus thrombosis—is understood. Some have suggested that all benign intracranial hypertension is caused by venous hypertension, mostly from stenoses or occlusions of the lateral sinuses. We describe a woman with refractory benign intracranial hypertension. With venography and manometry we showed partial obstruction of both transverse venous sinuses, with raised pressures proximal to the obstructions. Dilation of one of the sinuses with a stent reduced the pressure gradient, with striking symptomatic improvement. Investigation and treatment of benign intracranial hypertension should be revisited in view of these findings.