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Cerebral Venous Congestion, Intracranial Hypertension, and Venous Stenting

  • Abdalkader, M., Nguyen, T. N., Norbash, A. M., Raz, E., Shapiro, M., Lenck, S., Brinjikji, W., Weber, P., & Sakai, O. (2021). State of the art: Venous causes of pulsatile tinnitus and diagnostic considerations guiding endovascular therapy. Radiology, 300(1), 2–16. https://doi.org/10.1148/radiol.2021202584

  • Agarwal, V., Chandra, A., Haldipur, M., & Gupta, V. (2021). Cerebral venous sinus thrombosis: A comprehensive review. European Journal of Radiology, 139, 109717. https://doi.org/10.1016/j.ejrad.2021.109717

  • Alperin, N. J., Lee, S. H., Mazda, M., Hushek, S. G., Roitberg, B., Goddwin, J., & Lichtor, T. (2005). Evidence for altered cranial venous drainage in idiopathic intracranial hypertension and intracranial hypotension: A study using MR venography and MR flow quantification. Journal of Neurosurgery, 103(5), 883–889. https://doi.org/10.3171/jns.2005.103.5.0883

  • Arun, A., Amans MR, Higgins N, Brinjikji W, Sattur M, Satti SR, Nakaji P, Luciano M, Huisman TA, Moghekar A, Pereira VM, Meng R, Fargen K, Hui FK. A proposed framework for cerebral venous congestion. Neuroradiol J. 2022 Feb;35(1):94-111. doi: 10.1177/19714009211029261. Epub 2021 Jul 5. PMID: 34224274; PMCID: PMC8826290.

    Link: https://pmc.ncbi.nlm.nih.gov/articles/PMC8826290/

  • Ayanzen, R. H., Bird, C. R., Keller, P. J., McCully, F. J., Theobald, M. R., & Heiserman, J. E. (2000). Cerebral MR venography: Normal anatomy and potential diagnostic pitfalls. American Journal of Neuroradiology, 21(1), 74–78. https://www.ajnr.org/content/21/1/74

  • Bezerra, M. L. S., Ferreira, A., & de Oliveira-Souza, R. (2017). Pseudotumor cerebri and glymphatic dysfunction. Frontiers in Neurology, 8, 734. https://doi.org/10.3389/fneur.2017.00734

  • Bragée, C., Michos, A., Bragée, B., & Szulkin, R. (2020). Intracranial hypertension in myalgic encephalomyelitis/chronic fatigue syndrome. Frontiers in Neurology, 11, 828. https://doi.org/10.3389/fneur.2020.00828

  • Bussière, M., Falero, R., Nicolle, D., Proulx, A., Patel, V., Pelz, D. M., Lee, D., & Farb, R. I. (2010). Unilateral transverse sinus stenting of patients with idiopathic intracranial hypertension. American Journal of Neuroradiology, 31(4), 645–650. https://doi.org/10.3174/ajnr.A1898

  • Clausen TM, Fargen KM, Primiani CT, Sattur M, Amans MR, Hui FK. Post-acute sequelae of COVID infection and cerebral venous outflow disorders: Overlapping symptoms and mechanisms? Interv Neuroradiol. 2024 Sep 2:15910199241273946. doi: 10.1177/15910199241273946. Epub ahead of print. PMID: 39223825; PMCID: PMC11571337. https://pmc.ncbi.nlm.nih.gov/articles/PMC11571337/

  • Cognard, C., & Gobin, Y. P. (1995). Cerebral venous thrombosis: Imaging and intervention. Neuroimaging Clinics of North America, 5(3), 589–608. https://pubmed.ncbi.nlm.nih.gov/7480666/

  • Cooke, D. L., Amans, M. R., & Kim, H. (2017). Cerebral venous outflow disorders: Current evidence and clinical implications. Neurosurgical Focus, 42(6), E3. https://doi.org/10.3171/2017.3.FOCUS1718

  • Consoli, A., Cancelliere, N. M., Charbonnier, G., Nishi, H., Vanek, I., Marotta, T. R., Spears, J., & Pereira, V. M. (2025). Novel, braided, self-expandable stent designed for the treatment of pulsatile tinnitus caused by intracranial venous stenosis: First-in-human experience and long-term outcomes. Journal of NeuroInterventional Surgery, 17(5), 487. https://doi.org/10.1136/jnis-2024-021458

  • De Simone, R., Ranieri, A., Montella, S., & Fiorillo, C. (2019). The role of cranial venous outflow impairment in idiopathic intracranial hypertension pathogenesis: A review. Neurological Sciences, 40(S1), 45–52. https://doi.org/10.1007/s10072-019-03771-3

  • Donnet, A., Metellus, P., Levrier, O., & Bouillot, P. (2008). Endovascular treatment of idiopathic intracranial hypertension: Clinical and radiologic outcome of 10 consecutive patients. Neurology, 70(8), 641–647. https://doi.org/10.1212/01.wnl.0000297197.28547.30

  • Farb, R. I., Vanek, I., Scott, J. N., Mikulis, D. J., Willinsky, R. A., Tomlinson, G., & terBrugge, K. G. (2003).Idiopathic intracranial hypertension: The prevalence and morphology of sinovenous stenosis. Neurology, 60(9), 1418–1424. https://doi.org/10.1212/01.WNL.0000066683.34093.E0

  • Fargen, K. M. (2021). A unifying theory explaining venous sinus stenosis and recurrent stenosis following venous sinus stenting in patients with idiopathic intracranial hypertension. Journal of NeuroInterventional Surgery, 13(7), 587. https://doi.org/10.1136/neurintsurg-2020-017208

  • Fargen, K. M. (2020). Idiopathic intracranial hypertension is not idiopathic: Proposal for a new nomenclature and patient classification. Journal of NeuroInterventional Surgery, 12(2), 110. https://doi.org/10.1136/neurintsurg-2019-015498

  • Fargen KM, Amans MR, Hui FK. The cerebral venous disorders severity scale. J Neurointerv Surg. 2025 Jan 17;17(2):115-116. doi: 10.1136/jnis-2024-022976. PMID: 39824604. https://jnis.bmj.com/content/neurintsurg/17/2/115.full.pdf

  • Fargen, K. M., Garner, R. M., Kittel, C., & Wolfe, S. Q. (2020). A descriptive study of venous sinus pressures and gradients in patients with idiopathic intracranial hypertension. Journal of NeuroInterventional Surgery, 12(3), 320. https://doi.org/10.1136/neurintsurg-2019-015251

  • Fargen, K. M., Hui, F., & Hirsch, J. A. (2023). Cerebral venous disorders: The path forward. Journal of NeuroInterventional Surgery, 15(4), 309. https://doi.org/10.1136/jnis-2023-020251

  • Fargen, K. M., Kittel, C., Amans, M. R., Brinjikji, W., & Hui, F. (2023). A national survey of venous sinus stenting practices for idiopathic intracranial hypertension. Journal of NeuroInterventional Surgery, 15(5), 507. https://doi.org/10.1136/neurintsurg-2022-018832

  • Fargen, K. M., Liu, K. C., Garner, R. M., & Starke, R. M. (2021). Cerebral venous outflow disorders: Current perspectives and controversies. Journal of NeuroInterventional Surgery, 13(10), 866–874. https://doi.org/10.1136/neurintsurg-2020-016929

  • Fargen, K. M., Midtlien, J. P., Margraf, C. R., Wiater, A. H., Marcet, P. A., Siddiqui, A. H., & Hui, F. (2025). Cerebral venous pressures, sinus trans-stenosis gradients, and intracranial pressures are dramatically augmented by head position. Journal of NeuroInterventional Surgery, 17(10), 1120. https://doi.org/10.1136/jnis-2024-022167

  • Fargen, K. M., Midtlien, J. P., Margraf, C., Kiritsis, N. R., Chang, E., & Hui, F. (2025). Dynamic internal jugular vein venography: A descriptive study in 89 patients with suspected cerebral venous outflow disorders. Journal of NeuroInterventional Surgery, 17(6), 646. https://doi.org/10.1136/jnis-2024-021734

  • Fargen, K. M., Velat, G. J., Lewis, S. B., Hoh, B. L., Mocco, J., & Lawson, M. F. (2013). Concomitant intracranial pressure monitoring during venous sinus stenting for intracranial hypertension secondary to venous sinus stenosis. Journal of NeuroInterventional Surgery, 5(4), e22. https://doi.org/10.1136/neurintsurg-2012-010371

  • Fargen, K. M. (2022). Venous stenting for idiopathic intracranial hypertension: Lessons learned from a high-volume practice. Journal of NeuroInterventional Surgery, 14(6), 528. https://doi.org/10.1136/neurintsurg-2021-018184

  • Higgins, J. N. P., & Pickard, J. D. (2021). A paradigm for chronic fatigue syndrome: Caught between idiopathic intracranial hypertension and spontaneous intracranial hypotension; caused by cranial venous outflow obstruction. Fatigue: Biomedicine, Health & Behavior. Advance online publication. https://doi.org/10.1080/21641846.2021.1956223

  • Hoke, T., Torigoe, T., & Hui, F. (2025). E-017 Melanocortin-4 receptor deficiency is associated with cerebral venous congestion and intracranial pressure disorders. Journal of NeuroInterventional Surgery, 17(Suppl 1), A102. https://doi.org/10.1136/jnis-2025-SNIS.133

  • Hui FK, Ghozy S, Amans MR, Brinjikji W, Abdalkader M, Yedavalli V, Chyung AS, Pereira VM, Lenck S, Siddiqui AH, Hillis AE, Fargen KM. Cognitive impairment in cerebral venous congestion: The need for improved assessment tools - a literature review. J Neurointerv Surg. 2025 Jul 24:jnis-2025-023392. doi: 10.1136/jnis-2025-023392. Epub ahead of print. PMID: 40707244. https://jnis.bmj.com/content/early/2025/07/24/jnis-2025-023392.long

  • Iyer, A. M., Midtlien, J. P., Kittel, C., Klever, L. A., Wiater, A., Chang, E., Margraf, C., & Fargen, K. M. (2024). The correlation between intracranial pressure and venous sinus pressures changes after venous sinus stenting. Journal of NeuroInterventional Surgery, jnis-2024-022250. https://doi.org/10.1136/jnis-2024-022250

  • King, J. O., Mitchell, P. J., Thomson, K. R., & Tress, B. M. (1995). Cerebral venography and manometry in idiopathic intracranial hypertension. Neurology, 45(12), 2224–2228. https://doi.org/10.1212/WNL.45.12.2224

  • Kuhn, A., Singh, J., Massari, F., & Puri, A. (2022). E-117 Demographics, imaging findings, and diagnosis in patients with (post)coital headaches. Journal of NeuroInterventional Surgery, 14(Suppl 1), A140. https://doi.org/10.1136/neurintsurg-2022-SNIS.228

  • Li, M., Sun, Y., Cheng, C. C., Feng, C. Q., Ji, X. M., & Meng, R. (2019). Case series of venous sinus stenting for idiopathic intracranial hypertension associated with internal jugular vein stenosis. BMC Neurology, 19, 112. https://doi.org/10.1186/s12883-019-1337-5

  • Margraf, C. R., Hui, F. K., Midtlien, J. P., Wiater, A. H., Kittel, C. A., Ehrig, M. R., Hirshman, A. P., Siddiqui, A. H., & Fargen, K. M. (2025). Intracranial pressure is affected by head rotation: Effect of dynamic jugular stenosis on lumbar puncture opening pressure. Journal of NeuroInterventional Surgery, jnis-2025-023516. https://doi.org/10.1136/jnis-2025-023516

  • Morel, B., Hoffman, J., Folzenlogen, Z., Roark, C., Seinfeld, J., & Case, D. (2023). O-035 Endovascular treatment of cerebral venous thrombosis involving the deep venous system. Journal of NeuroInterventional Surgery, 15(Suppl 1), A29. https://doi.org/10.1136/jnis-2023-SNIS.35

  • Nicholson, P., Brinjikji, W., Radovanovic, I., Hilditch, C. A., Tsang, A. C. O., Krings, T., Mendes Pereira, V., & Lenck, S. (2019). Venous sinus stenting for idiopathic intracranial hypertension: A systematic review and meta-analysis. Journal of NeuroInterventional Surgery, 11(4), 380. https://doi.org/10.1136/neurintsurg-2018-014172

  • Owler, B. K., Parker, G., & Halmagyi, G. M. (2003). Cranial venous outflow obstruction and pseudotumor cerebri syndrome. Journal of Neurosurgery, 98(5), 1045–1055. https://doi.org/10.3171/jns.2003.98.5.1045

  • Pang, S., Kolarich, A. R., Brinjikji, W., Nakaji, P., Hepworth, E., & Hui, F. (2022). Interventional and surgical management of internal jugular venous stenosis: A narrative review. Journal of NeuroInterventional Surgery, 14(5), 503. https://doi.org/10.1136/neurintsurg-2021-017937

  • Peterson, K. A., Kittel, C., Lee, K. E., Garner, R., Nechtman, C. M., Brown, P., Wolfe, S. Q., & Fargen, K. M. (2021). Angiographic cerebral venous sinus calibers and drainage patterns in patients with normal intracranial pressure and idiopathic intracranial hypertension. Journal of NeuroInterventional Surgery, 13(10), 958. https://doi.org/10.1136/neurintsurg-2020-016976

  • Primiani CT, Lawton M, Hillis AE, Hui FK. Pearls & oy-sters: Cerebral venous congestion associated with cognitive decline treated by jugular release. Neurology. 2022 Sep 27;99(13):577-580. doi: 10.1212/WNL.0000000000201037. Epub 2022 Jul 18. PMID: 35851254. https://pubmed.ncbi.nlm.nih.gov/39824604/https://www.neurology.org/doi/10.1212/WNL.0000000000201037

  • Rowe, P. C., Marden, C. L., Heinlein, S., & Edwards, C. C. II. (2018). Improvement of severe myalgic encephalomyelitis/chronic fatigue syndrome symptoms following surgical treatment of cervical spinal stenosis. Journal of Translational Medicine, 16, 21. https://doi.org/10.1186/s12967-018-1397-7

  • Samaniego, E. A., Abrams, K. J., Dabus, G., Starr, R., & Linfante, I. (2013). Severe venous congestive encephalopathy secondary to a dialysis arteriovenous graft. Journal of NeuroInterventional Surgery, 5(5), e37. https://doi.org/10.1136/neurintsurg-2012-010355

  • Sattur, M. G., Amans, M. R., Fargen, K. M., Huisman, T. A. G. M., Brinjikji, W., Hui, F. K., … Spiotta, A. M. (2022). Angiographic evaluation of cranial venous outflow patterns in patients with and without idiopathic intracranial hypertension. Operative Neurosurgery, 00(1), 1–7. https://doi.org/10.1227/ons.0000000000000413

  • Shapiro, M., Raz, E., Nossek, E., Srivatanakul, K., Young, M., Narayan, V., Ali, A., Sharashidze, V., Esparza, R., & Nelson, P. K. (2023). Cerebral venous anatomy: Implications for the neurointerventionalist. Journal of NeuroInterventional Surgery, 15(5), 452. https://doi.org/10.1136/neurintsurg-2022-018917

  • Starke, R. M., Wang, T. R., Ding, D., Durst, C. R., Crowley, R. W., & Liu, K. C. (2015). Venous sinus stenting for idiopathic intracranial hypertension: A review of the literature. Journal of NeuroInterventional Surgery, 7(8), 652–659. https://doi.org/10.1136/neurintsurg-2014-011355

  • Townsend, R. K., Jost, A., Amans, M. R., Hui, F., Bender, M. T., Satti, S. R., Maurer, R., Liu, K., Brinjikji, W., & Fargen, K. M. (2022). Major complications of dural venous sinus stenting for idiopathic intracranial hypertension: Case series and management considerations. Journal of NeuroInterventional Surgery, 14(1), neurintsurg-2021-017361. https://doi.org/10.1136/neurintsurg-2021-017361

  • Tschoe, C., Garner, R. M., Kittel, C., Traunero, J. R., Wolfe, S. Q., & Fargen, K. M. (2020). Changes in mean arterial pressure and end-tidal carbon dioxide content affect venous sinus pressures in patients with idiopathic intracranial hypertension: A randomized study. Journal of NeuroInterventional Surgery, 12(9), 906. https://doi.org/10.1136/neurintsurg-2019-015741

  • Wang, Z., Ding, J., Bai, C., Ding, Y., Ji, X., & Meng, R. (2020). Clinical classification and collateral circulation in chronic cerebrospinal venous insufficiency. Frontiers in Neurology, 11, 913. https://doi.org/10.3389/fneur.2020.00913
    Link: https://doi.org/10.3389/fneur.2020.0091

  • Wei, H., Jiang, H., Zhou, Y., Xiao, X., Zhou, C., & Ji, X. (2023). Cerebral venous congestion alters brain metabolite profiles, impairing cognitive function. Journal of Cerebral Blood Flow & Metabolism, 43(11), 1857–1872. https://doi.org/10.1177/0271678X231182244

  • Wei H, Jiang H, Zhou Y, Xiao X, Zhou C, Ji X. Cerebral venous congestion alters brain metabolite profiles, impairing cognitive function. J Cereb Blood Flow Metab. 2023 Nov;43(11):1857-1872. doi: 10.1177/0271678X231182244. Epub 2023 Jun 13. PMID: 37309740; PMCID: PMC10676144. https://pmc.ncbi.nlm.nih.gov/articles/PMC10676144/

  • Wei, H., Jiang, H., Zhou, Y. et al. Cerebral venous congestion alters CNS homeostatic plasticity, evoking tinnitus-like behavior. Cell Biosci 14, 47 (2024). https://doi.org/10.1186/s13578-024-01221-9

  • West, J. L., Greeneway, G. P., Garner, R. M., Aschenbrenner, C. A., Singh, J., Wolfe, S. Q., & Fargen, K. M. (2019). Correlation between angiographic stenosis and physiologic venous sinus outflow obstruction in idiopathic intracranial hypertension. Journal of NeuroInterventional Surgery, 11(1), 90. https://doi.org/10.1136/neurintsurg-2018-014004

  • Zamboni, P., Scerrati, A., Menegatti, E., Galeotti, R., Tessari, M., & Taibi, A. (2019). Internal jugular vein compression by the styloid process and the transverse process of C1 as a cause of chronic cerebrospinal venous insufficiency. BMC Neurology, 19, 333. https://doi.org/10.1186/s12883-019-1585-2

  • Zeng, X., Wang, Y., & Liu, L. (2025). Novel insights into the pathophysiology of idiopathic intracranial hypertension: A commentary on brain volume and transverse sinus stenosis. Journal of NeuroInterventional Surgery, 17(6), e8. https://doi.org/10.1136/jnis-2024-022817

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