{
  "abstract": "Introduction Venous sinus stenting (VSS) is an emerging and effective treatment for medically refractory idiopathic intracranial hypertension (IIH) associated with transverse sinus stenosis. Eligibility for VSS is defined by trans-stenotic pressure gradients measured while awake. Awake manometry often imposes a significant procedural and patient burden. However, the validity of venous sinus manometry under general anesthesia (GA) for clinical decision making has remained an area of debate. In this study, we sought to revisit this to determine whether venous manometry performed under GA with controlled ventilatory parameters is appropriate for clinical decision making.Methods We conducted a single center retrospective study of adults with IIH who underwent venous sinus manometry while awake and under GA between 2021 and 2025. Cerebral venous sinus pressures and gradients were measured using a standardized microcatheter technique using a 0.027 inch microcatheter connected to a pressure transducer. Pressure measurements were made at three points along the superior sagittal sinus, torcular, medial transverse sinus, lateral transverse sinus, upper and lower sigmoid sinus, and internal jugular vein. Pressure gradients measured included a global pressure gradient, measured as the difference between anterior superior sagittal sinus pressure and internal jugular venous pressure. In addition a trans-stenotic gradient was measured, defined as the pressure difference between points just proximal and distal to the area of radiographic stenosis. Additional data points recorded included age, BMI, CSF opening pressure, and baseline grade of papilledema. Primary outcomes included differences in absolute pressures and pressure gradients between awake and sedated states. Data was evaluated through univariate and multivariable analysis.Results 29 patients met enrollment criteria. Venous pressure gradients were preserved between awake and asleep measurements despite variations in absolute venous pressures. Additionally, sedated measurements reproduced awake treatment decisions with 100% agreement for the global SS-IJ (superior sagittal-internal jugular) gradient. For trans-stenotic gradients, reclassification occurred in 5 (17%) patients at the 8-mmHg threshold, all with a BMI over 40. Additionally, on multivariable linear regression controlling for Age and respiratory parameters, reclassified patients demonstrated significantly higher BMI (p=0.038), and reclassification occurred exclusively in the patients with BMI > 37.Conclusion In patients with IIH, venous sinus pressure gradients remain stable across awake and sedated conditions when controlling ventilatory parameters especially in patients with less than Class III obesity.Disclosures A. Helal: None. M. Salem: None. Z. Folzenlogen: None. C. Roark: None.",
  "authors": [
    {
      "affiliations": [
        "Neurosurgery, University of Colorado, Aurora, CO"
      ],
      "name": "A Helal"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO"
      ],
      "name": "R Moseley"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Colorado, Aurora, CO"
      ],
      "name": "M Salem"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Colorado, Aurora, CO"
      ],
      "name": "Z Folzenlogen"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Colorado, Aurora, CO"
      ],
      "name": "C Roark"
    },
    {
      "affiliations": [
        "University of Colorado, Aurora, CO"
      ],
      "name": "J Seinfeld"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Colorado, Centennial, CO"
      ],
      "name": "D Case"
    }
  ],
  "title": "O-057 Asleep venous sinus manometry is appropriate for clinical decision making, especially in patients with class II obesity or less; a cohort study",
  "uid": "99445f05-d1e8-5f7a-a91a-9319b3e4133e"
}