Cranial Venous Outflow Obstruction and Pseudotumor Cerebri Syndrome

  • B. K. Owler
  • G. Parker
  • G. M. Halmagyi
  • I. H. Johnston
  • M. Besser
  • J. D. Pickard
  • J. N. Higgins
Part of the Advances and Technical Standards in Neurosurgery book series (NEUROSURGERY, volume 30)


The pathophysiology of PTS including idiopathic intracranial hypertension or ‘BIH’, remains controversial. The older literature frequently referred to pathology in the cerebral venous drainage but more modern imaging techniques (CT and early MR) failed to reveal gross venous pathology. The role of impaired cranial venous outflow has recently been re-examined in the light of new methods of investigation (advanced MR venography and direct microcatheter venography with manometry) and of treatment (venous sinus stenting).

Venous sinus obstruction in PTS is a more common factor in the pathogenesis of the condition than previously recognised. Venous obstruction may be primary, that is, it is the underlying aetiological factor in PTS. Venous sinus obstruction may also be secondary to raised CSF pressure which may exacerbate problems with intracranial compliance and raised CSF pressure. Early experience with venous stenting suggests that it may be a helpful treatment for patients with PTS but more experience and longer follow-up is required to define the subgroups of patients for whom it is most appropriate.


Pseudotumor cerebri syndrome idiopathic intracranial hypertension benign intracranial hypertension papilloedema intracranial pressure cerebral venous drainage venous stent MR venography 


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Copyright information

© Springer-Verlag/Wien 2005

Authors and Affiliations

  • B. K. Owler
    • 1
    • 2
  • G. Parker
    • 3
  • G. M. Halmagyi
    • 1
  • I. H. Johnston
    • 1
  • M. Besser
    • 1
    • 2
  • J. D. Pickard
    • 4
  • J. N. Higgins
    • 5
  1. 1.T. Y. Nelson Departments of Neurosurgery and NeurologyInstitute of Clinical Neurosciences, Royal Prince Alfred HospitalSydneyAustralia
  2. 2.Department of SurgeryUniversity of SydneySydneyAustralia
  3. 3.Department of RadiologyRoyal Prince Alfred HospitalSydneyAustralia
  4. 4.Department of NeurosurgeryAcademic Neurosurgical Unit, University of Cambridge, Addenbrookes HospitalCambridgeUK
  5. 5.Department of NeuroradiologyAddenbrookes HospitalCambridgeUK

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