TECHNICAL NOTE J Neurosurg 130:1992–1996, 2019 I ntracranIal lateral venous sinus (LS) stenoses have been associated with idiopathic intracranial hyperten- sion (IIH) 12 and venous pulsatile tinnitus (PT). 2,6 The measurement of the venous transstenotic pressure gradi- ent (TSG) is traditionally performed in patients with IIH to assess the indications for stenting. 12 However, both the reliability of this technique and the value of the threshold TSG have been questioned by many authors. 4,7 The clinical assessment of PT may be challenging in patients without IIH, and the discovery of LS stenoses can be incidental. 5 It can be therefore diffcult to ascertain the role that these stenoses play in patients with PT. There is a clear need for a more precise diagnostic tool to help determine reli- able hemodynamic criteria, which will help better predict which patients with symptomatic LS stenoses will beneft from stenting. A dual-sensor wire is commonly used in cardiology to measure both pressures and velocity across an atherosclerotic lesion. This physiological approach has proven more benefcial in the selection of therapeutic tar - gets for coronary revascularization compared with mea- surement of pressures alone. 9 The purpose of the present study was to evaluate the hemodynamic consequences of symptomatic dural-sinus stenoses in terms of venous blood fow velocities (BFVs) and venous pressures in a prospective series of 14 patients in whom exploration was performed using a dual-sensor pressure and Doppler velocity guidewire. Methods After receiving institutional review board approval, we collected the clinical, radiological, and hemodynamic data of patients in whom exploration was performed using a dual-sensor guidewire (ComboWire, Volcano Corporation [Philips]) for a disabling venous PT, with or without IIH, associated with an ipsilateral LS stenosis confrmed on imaging. Written informed consent was obtained before the procedure for all patients according to local institu- tional protocol. All patients underwent an otoscopic exam- ination, MRI with MR angiography and MR venography, and bone CT scanning to exclude other causes of PT. Using local anesthesia, the diagnostic procedures were performed via a 5-F venous femoral sheath. The stent placement and the poststenting hemodynamic measure- ABBREVIATIONS BFV = blood flow velocity; IIH = idiopathic intracranial hypertension; LS = lateral sinus; PT = pulsatile tinnitus; TSG = transstenotic pressure gradient. SUBMITTED September 21, 2017. ACCEPTED December 19, 2017. INCLUDE WHEN CITING Published online June 1, 2018; DOI: 10.3171/2017.12.JNS172364. Assessment of blood fow velocities and venous pressures using a dual-sensor guidewire in symptomatic dural sinus stenoses Stéphanie Lenck, MD, 1 Fabrice Vallée, MD, 2 Vittorio Civelli, MD, 1 Jean-Pierre Saint-Maurice, MD, 1 Patrick Nicholson, MD, 3 Alex Hong, MD, 2 and Emmanuel Houdart, MD 1 Departments of 1 Neuroradiology and 2 Anesthesiology and Critical Care, Hôpital Lariboisière, Paris, France; and 3 Department of Neuroradiology, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada Lateral venous sinus stenoses have been associated with idiopathic intracranial hypertension and venous pulsatile tin- nitus. Venous pressure measurement is traditionally performed to assess the indications for stenting in patients with idiopathic intracranial hypertension. However, its reliability has recently been questioned by many authors. The dual- sensor guidewire was frst developed for advanced physiological assessment of fractional and coronary fow reserves in coronary artery stenoses. It allows measurement of both venous pressure and blood fow velocities. The authors used this device in 14 consecutively treated patients to explore for symptomatic lateral sinus stenosis. They found that venous blood fow was signifcantly accelerated inside the stenotic lesion. This acceleration, as well as the pulsatile tinnitus, resolved in all patients following stent placement. According to the authors’ results, this guidewire can be helpful for es- tablishing an indication for stenting in patients with pulsatile tinnitus and idiopathic intracranial hypertension. https://thejns.org/doi/abs/10.3171/2017.12.JNS172364 KEYWORDS idiopathic intracranial hypertension; pulsatile tinnitus; venous sinus stenoses; dual-sensor guidewire; diagnostic technique; vascular disorders J Neurosurg Volume 130 • June 2019 1992 ©AANS 2019, except where prohibited by US copyright law Unauthenticated | Downloaded 02/16/23 03:13 PM UTC