Cerebral venous pressure, intra-abdominal pressure, and dural venous sinus stenting in idiopathic intracranial hypertension

Increased pressure in the dural venous sinuses has been proposed as the cause of increased intracranial pressure in the condition known as idiopathic intracranial hypertension (IIH). This hypothesis has received further support from manometry of the dural venous sinuses, showing a substantial proximal-to-distal pressure gradient, and from reports of improvement of IIH following stenting of the dural sinuses. Increased intracranial venous pressure has also been proposed as the cause of IIH in morbid obesity through increased abdominal pressure that is transmitted through the thorax to the cerebral draining veins. Although these hypotheses are intriguing, neither has enough scientific support to be endorsed yet. Moreover, dural venous sinus stenting should not be adopted as a therapeutic procedure in IIH until larger clinical trials attest to its safety and efficacy.