Clinical and hemodynamic responses to balloon test occlusion of the straight sinus: technical case report.

Abstract

Surgical sacrifice of the straight sinus may be performed during intracranial tumor resection. Sacrifice of the straight sinus is associated with an unpredictable risk of venous infarction. We describe a patient with a falcine meningioma who underwent endovascular balloon test occlusion of the straight sinus before surgical resection. A 48-year-old woman presented with symptoms resulting from a 4-cm-diameter meningioma in the left occipital region. Along its inferior margin, the tumor abutted the straight sinus. Cerebral angiography demonstrated occlusion of the posterior one-third of the superior sagittal sinus but patency of the straight sinus. A 4-mm angioplasty balloon was directed into the straight sinus via the right jugular vein. In addition to clinical assessments, the pressure within the proximal straight sinus, upstream from the balloon, was measured before and during inflation. Severe headaches followed balloon inflation, and the pressure in the proximal straight sinus increased 18 mm Hg. With balloon deflation, the clinical and hemodynamic findings immediately returned to normal. On the basis of these findings, the straight sinus was preserved during surgery. This technique is straightforward and allows some assessment of the physiological responses and individual tolerance to sinus occlusion before surgery.