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Superior sagittal sinus-to-internal jugular vein bypass shunt with covered stent construct for intractable intracranial hypertension resulting from iatrogenic supratorcular sinus occlusion: technical note

  • Technical Note - Vascular Neurosurgery - Other
  • Published:
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Abstract

Background

Acute occlusion of the posterior sagittal sinus may lead to dramatic increase in intracranial pressure (ICP), refractory to standard treatment. Hybrid vascular bypass of cranial venous outflow into the internal jugular vein (IJV) has seldom been described for this in recent neurosurgical literature.

Objective

To describe creation of a novel vascular bypass shunt from the superior sagittal sinus (SSS) to internal jugular vein (IJV) utilizing a covered stent-Dacron graft construct for control of refractory ICP.

Methods

We illustrate a patient with refractory ICP increases after acute sinus ligation that was performed to halt torrential bleeding from intraoperative injury. A temporary shunt was created that successfully controlled ICP. From the promising results of the temporary shunt, we utilized a prosthetic hybrid bypass graft to function as a shunt from the sagittal sinus to IJV. Yet the associated anticoagulation led to complications and a poor outcome.

Results

Rapid and sustained ICP reduction can be expected after sagittal sinus-to-jugular bypass shunt placement in acute sinus occlusion. Details of the surgical technique are described. Heparin anticoagulation, while imperative, is also associated with worrisome complications.

Conclusion

Acute occlusion of posterior third of sagittal sinus carries a very malignant clinical course. Intractable intracranial hypertension from acute sinus occlusion may be effectively treated with a SSS-IJV bypass shunt. A covered stent construct provides an effective vascular bypass conduit. However, the anticoagulation risk can lead to fatal outcomes. The neurosurgeon must always strive for primary repair of an injured sinus.

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Authors and Affiliations

  1. Department of Neurosurgery, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 301 CSB, Charleston, SC, 29425, USA

    Mithun G. Sattur, Aimee Weber, Jaime Martinez Santos, Orgest M. Lajthia & Alejandro M. Spiotta

  2. Department of Vascular Surgery, Medical University of South Carolina, Charleston, SC, USA

    Elizabeth A. Genovese, Joseph M. Anderson, Mathew D. Wooster & Ravikumar Veeraswamy

Authors
  1. Mithun G. Sattur
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  2. Elizabeth A. Genovese
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  3. Aimee Weber
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  4. Jaime Martinez Santos
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  5. Orgest M. Lajthia
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  6. Joseph M. Anderson
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  7. Mathew D. Wooster
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  8. Ravikumar Veeraswamy
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  9. Alejandro M. Spiotta
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Corresponding author

Correspondence to Mithun G. Sattur.

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Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Medical University of South Carolina) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Conflict of interest

Dr. Wooster was provided financial support in the form of an educational honorarium and is on the Speakers Bureau for Gore Medical (W.L. Gore & associates, Flagstaff, AZ). The sponsor had no role in the design or conduct of this research. All other authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

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This article is part of the Topical Collection on Vascular Neurosurgery - Other

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Sattur, M.G., Genovese, E.A., Weber, A. et al. Superior sagittal sinus-to-internal jugular vein bypass shunt with covered stent construct for intractable intracranial hypertension resulting from iatrogenic supratorcular sinus occlusion: technical note. Acta Neurochir 163, 2351–2357 (2021). https://doi.org/10.1007/s00701-021-04866-4

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  • DOI: https://doi.org/10.1007/s00701-021-04866-4

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