{
  "abstract": "Background Intracranial mass lesions may compress or invade the dural venous sinuses or jugular veins, resulting in cerebral venous outflow obstruction. Endovascular techniques, including venous sinus stenting, angioplasty have been increasingly reported as therapeutic options, but the available literature is limited to small, heterogeneous reports. Here we systematically review the literature, focusing on devices used, antithrombotics, and outcomes.Methods A systematic PubMed search was performed using keywords including mass, tumor, meningioma, venous sinus, venous outflow obstruction, stent, and endovascular. A total of 166 records were screened, with 20 duplicates removed. Additional studies were acquired from reference mining. We included case reports and case series containing original patient-level data describing endovascular management of venous outflow obstruction secondary to intracranial mass lesions. Extracted variables included patient demographics, mass location and venous segment involved, endovascular technique, antithrombotic regimen, clinical outcomes, and duration of follow-up.Results A total of 13 studies, including 43 patients, were included. Meningioma-related venous obstruction was the most common (42/43). The most commonly involved venous segments were the superior sagittal sinus (19; 44.2%) and the transverse/transverse-sigmoid sinus region (19; 44.2%), with less frequent involvement of the torcula (3; 7.0%) and jugular bulb/jugular foramen region (2; 4.7%). Endovascular strategies included venous sinus stenting (41; 95.3%) and balloon venoplasty only (2; 4.7%), with occasional adjunct tumor-directed therapies and one case requiring CSF diversion. Among cases in which device details were explicitly reported, self-expanding stents predominated, most commonly open-cell carotid or peripheral platforms such as Precise/Precise Pro and Protégé. Closed-cell self-expanding stents (e.g., Wallstent, Casper) were also used, particularly in long or sagittal sinus lesions. Balloon-expandable stents, all of which were closed-cell designs, were employed less frequently (e.g., Express, Omnilink, Resolute Onyx). Several series did not report device-level detail per patient, precluding complete classification across all cases. Antithrombotic regimens were heterogeneous, most commonly involving peri-procedural heparinization and dual antiplatelet therapy followed by aspirin monotherapy; select cases employed anticoagulation or alternative antiplatelet strategies.In all patients in whom papilledema was present at baseline, resolution or marked improvement was achieved (18/18; 100%). Headache outcomes were more variable. Long-term follow-up demonstrated that restenosis or tumor-related venous re-narrowing may occur, sometimes necessitating repeat endovascular intervention. Procedural complications were uncommon, although delayed in-stent thrombosis was reported in one case. The only reported acute technical failure of endovascular stenting was subsequently managed with tumor embolization, with sufficient subsequent tumor shrinkage over approximately 10 months to reduce sinus stenosis and resolve symptoms.Conclusions Endovascular management, especially stenting, represents a viable therapeutic option for cerebral venous outflow obstruction secondary to intracranial mass lesions, with particularly favorable outcomes for papilledema and visual dysfunction. Most of the literature involves meningiomas. There was no clear association with device used and treatment success.Disclosures A. Brake: None. K. John: None. M. Zanaty: None.",
  "authors": [
    {
      "affiliations": [
        "Neurology/Radiology, University of Iowa Healthcare, Iowa City, IA"
      ],
      "name": "A Brake"
    },
    {
      "affiliations": [
        "Radiology, University of Michigan, Ann Arbor, MI"
      ],
      "name": "K John"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Iowa Healthcare, Iowa City, IA"
      ],
      "name": "M Zanaty"
    }
  ],
  "title": "E-301 Endovascular management of cerebral venous outflow obstruction secondary to intracranial mass lesions: a systematic review",
  "uid": "996ea093-419f-5afa-9035-c3bc80f7c03f"
}