Fig 1.
Patterns of venous sinus system dominance on MRV.
A: Co-dominant sinus system (Double white arrows on each dominant transverse sinus; TS); B: Dominant-Hypoplastic sinus system (Double white arrows: Dominant TS and Single white arrow: Hypoplastic TS); C: Dominant-Aplastic sinus system (Double white arrows: Dominant TS; *: Aplastic sinus; Single white arrow: Collateral venous channel draining inferior sagittal sinus.
Fig 2.
Alteration in flow dynamics following venous sinus stenting in different dominance patterns of transverse sinuses.
Patient-1 (A&B): Dominant-aplastic system (white arrow) with venous collaterals (Black arrow). Post venous stent preferential flow across the unilateral dominant sinus with no opacification of collaterals. Patient-2 (C&D): Dominant (white arrow)-Hypoplastic (black arrow) system. Post venous stent preferential flow across the left dominant TS (white arrow) with non-visualization of hypoplastic TS. Patient-3 (E&F): Co-dominant sinus system (white arrows). Post venous stent of non-dominant (right) hemisphere TS shows preferential flow across right TA (white arrow) and slow flow on the contralateral side (black arrow).
Fig 3.
Impact of venous sinus stenting on trans-stenotic venous gradient.
The trans-stenotic gradient before (blue) and after (Orange) venous stenting for each patient in the study population were plotted along the horizontal axis and trans-stenotic gradient (mm Hg) was marked along the vertical axis. Note the significant reduction of trans-stenotic pressure gradient following venous stent (p<0.001) in the entire study population.
Fig 4.
Impact of venous sinus stenting on Tinnitus severity (THI Grade).
The tinnitus severity based on THI grade before (blue) and after (orange) the venous stenting for individual patients were plotted along the horizontal axis and THI severity grade was marked along the vertical axis. Complete resolution of tinnitus (grade-1) noted in all except one patient following venous stenting. One patient with grade-1(minimal) tinnitus pre-stent remained unchanged in severity following VSS (Patient-9). Please note THI grade-1 represents both mild and no tinnitus.
Fig 5.
Impact of venous sinus stenting on Tinnitus severity (THI sum score).
The tinnitus severity based on THI sum score before (blue) and after (orange) the venous stenting for individual patients were plotted along the horizontal axis and THI sum score was marked along the vertical axis. Complete resolution of tinnitus was noted in all except one patient following venous stenting. Evaluation based on sum score provides clear difference in the tinnitus improvement, especially in THI grade-1 patients (Patient-9).