Our group has historically used a setup that includes a 6-F guiding sheath and advancing a Carotid Wallstent (Boston Scientific Corporation) over 0.014-inch guidewires to cross the lesion. The investigators found that every patient who underwent stenting for venous sinus stenosis had significant improvement in intracranial pressure and all visual parameters. al. Clipboard, Search History, and several other advanced features are temporarily unavailable. You may also have swelling in the arm or leg where the catheter was inserted. 2017 Apr;23 (2):186-193. doi: 10.1177/1591019916680110. Venous Sinus Stenting & Vascular Procedures . Background Venous sinus stenting (VSS) is a safe, effective, and increasingly popular treatment option for selected patients with idiopathic intracranial hypertension (IIH). Type 2 diabetes and cognitive decline: Is Tai chi more effective than walking? It is yet to be fully Your doctor will insert this catheter into the blood vessel until it is at the area to be treated. Neurol Clin. What to expect during venous stenting. Medically refractory increased intracranial pressure may warrant procedural intervention to prevent permanent vision loss (e.g., optic nerve sheath fenestration, serial lumbar punctures, and CSF shunting). Can diet help improve depression symptoms? [8]. PMC JAMA Neurol. Bethesda, MD 20894, Web Policies Through this study, we want to share our experience with venous stenting in refractory IIH patients with venous sinus stenosis associated with a significant pressure gradient (10 mm Hg). Neurology. Prestenting mean trans-stenosis pressure gradient was 18 mm Hg (SD = 6.16; 95% CI = 13.43-22.57). Transient Visual Obscurations(TVOs): 66.7% had complete resolution following stent placement. After treatment, >75% exhibit an improvement in headaches, ~50% improvement in tinnitus, and ~50 % improvement in . Hemorrhage from venous perforation occurs in approximately 2% of reported cases and often results in subdural or epidural hematoma. Females accounted for 67.7% (42/62). official website and that any information you provide is encrypted Prostate enlargement (benign prostatic hyperplasia). Over the past decade, there has been growing interest in venous sinus stenting as a primary treatment for idiopathic intracranial hypertension (IIH) refractory to medical therapy. Unauthorized use of these marks is strictly prohibited. 2019 Jan;121:e165-e171. Numbness, coolness or color change in the arm or leg where the catheter was inserted. This may require an additional stent to be put in. The bile ducts connect the liver to the small intestine to allow bile through, which helps in the digestion of food. Seek emergency medical attention for signs and symptoms of a heart attack, TIA, stroke, or difficulty breathing. The role of dural sinus stenosis in idiopathic intracranial hypertension pathogenesis: The self-limiting venous collapse feedback-loop model. The site is secure. Phone: (646) 962-9476, Weill Cornell Medicine researchers are now designing a head-to-head randomized trial between venous sinus stenting and shunting. Dural venous sinus stenting for medically and surgically refractory idiopathic intracranial hypertension Interv Neuroradiol. People may have a sedative, a numbing medicine at the back of the throat, or a general anesthetic. Results: A total of 120 paired pressure . and transmitted securely. Although stent placement does not cure the underlying condition, it may help ease symptoms. . Friedman DI, Liu GT, Digre KB. Neurology. Brain: a journal of neurology, 114 ( Pt 1A), 155-80. Interv Neuroradiol. Unilateral or bilateral transverse sinus (TS) or transverse-sigmoid junction stenosis is present in about 30%-93% of these patients. During recovery, a nurse will check your blood pressure and heart rate regularly. 8600 Rockville Pike Figure 1. To really move the field forward and have venous sinus stenting accepted as standard of care for patients refractory to medical therapy, we will likely need to study the safety and efficacy in a more rigorous fashion, including prospective registries and clinical trials. People can make sure to monitor their condition, make healthy lifestyle choices, and attend regular checkups to help prevent complications after having a stent placement. The interventional neurologist will determine if placing a venous stent can improve the condition. Papilledema rarely causes severe visual acuity loss; visual field assessments are more useful. This is also known as idiopathic intracranial hypertension (IIH). This can result in a blood clot, which can block blood flow to the heart and cause a heart attack. The venous sinus stenting procedure involves inserting a stent in the brain to widen the narrowed veins. Weill Cornell MedicineOffice of External Affairs Would you like email updates of new search results? 2014;71(6):693701. In other cases, people may need a general anesthetic and to stay in hospital for slightly longer. Associate Professor of Neurosurgery and Interventional Neuroradiology zcan SC, Deveci N, zarslan zcan D, nder F. Turk J Ophthalmol. Fainting, dizziness or feeling very tired. Lee, Alex Sinclair, Sadaka, Ama & Berry, Shauna & Mollan, Susan. Dural venous sinus stenting came into favor in the mid-2010s, and 5- to 10-year data do not exist. A discussion of patient selection, current data, and available tools and techniques. The River stent (Serenity Medical, Inc.) is currently being studied for treatment of venous stenosis in IIH. government site. Alternatively, ICP lowering CSF shunting procedures (e.g., lumbo-peritoneal shunts and ventriculoperitoneal shunts), may provide better control of intractable and refractory headaches. Vascular stenting can be used to treat a number of conditions. Activated clotting time (ACT) was checked 5 min later and was only 189 s, and so another 5000 units of intravenous heparin (total of 14 000 units) was given with an . A doctor will use an ultrasound or X-ray to locate the kidneys, and then insert a thin wire through the skin into the ureter. Methods: We retrospectively reviewed the records of eighteen patients diagnosed with IIH who underwent venous sinus stenting for transverse sinus stenosis with a mean pressure gradient (MPG) of at least 4 mmHg. The mean pressure gradient measured proximally and distally to the area of focal obstruction . Before Your body may also be injected with a special dye to show the flow of blood through your blood vessels. However, you may feel some pain when the angioplasty balloon is inflated. Unauthorized use of these marks is strictly prohibited. doi: 10.3171/2018.4.FOCUS18100. Everything you need to know, New, biodegradable stent 'as good as current gold standard', Peripheral artery disease: Symptoms, causes, and more, Debra Sullivan, Ph.D., MSN, R.N., CNE, COI, Everything you need to know about carotid artery disease, swelling in the legs, feet, abdomen, or neck veins, sudden weakness or paralysis in one side of the body, one foot or lower leg feels colder than the other leg or other areas of the body, poor growth of toenails or hair on the legs, in males, particularly with diabetes, erectile dysfunction, increased urgency and frequency of urinating, pain during urination or after ejaculation, the feeling of food getting stuck in the chest, food returning up towards the throat after swallowing, bronchial stent to keep open the bronchia, major air passageways within the lungs, airway stenosis, including laryngeal stenosis and tracheal stenosis, airway fistulas, including tracheoesophageal fistula (TEF) and bronchoesophageal fistula (BEF), airway complications after lung transplant, chronic obstructive lung diseases including asthma, chronic obstructive pulmonary disease (COPD) and bronchiectasis, allergic reaction to contrast dye, if the procedure uses this, for prostatic stents, urinating problems, urinary tract infections, or prostate inflammation are. In this article, learn more about the procedure, Angioplasty is a medical procedure that opens a blocked or narrowed artery close to the heart. Fifty-seven percent of the patients had severe right transverse sigmoid sinus stenosis (n = 4) and the rest (43%) had bilateral TS stenosis (n = 3). The ureters are tubes that transport urine to the bladder from the kidneys. Angioplasty and vascular stenting. A buildup of plaque in these arteries can narrow the arteries and lead to peripheral artery disease. A blockage in the ureter can stop urine flow. Interest in, and experience of, this technique is growing, particularly in recent years. Chen Z, Ding J, Wu X, Cao X, Liu H, Yin X, Ding Y, Ji X, Meng R. Neurologist. Conditions that may cause a biliary obstruction can include pancreatic cancer, pancreatitis, or gallstones. People may be able to return to work within a few days or a week after their stent placement. Authors Sudhakar R Satti 1 , Lakshmi Leishangthem 2 , Alejandro Spiotta 3 , M Imran Chaudry 4 Affiliations Symptoms & causes of kidney stones. Weill Cornell Medicine researchers are now designing a head-to-head randomized trial between venous sinus stenting and shunting. The initial treatment for IIH consists of weight loss and discontinuation of possible causal factors such as excessive vitamin A, steroids, or tetracyclines. Keywords: Barrero Ruiz E, Iglesias Moroo S, Ros Lpez B, Morales Martinez A, Daz T, Arrez Snchez M. But literally the moment I woke up from the procedure I could hear again. The mean trans-stenotic pressure gradients were 6~43 mmHg prior to stenting and returned to 0~4 mmHg after stent placement. 56. https://doi.org/10.1097/WNO.000000000000042, https://eyewiki.org/w/index.php?title=Venous_Stenting_in_Idiopathic_Intracranial_Hypertension_(IIH)&oldid=89943. Venous sinus stenting is the experimental procedure being tested in this protocol and consists of placing a stent into the narrowed veins of the brain. Verostek was successfully treated with the venous sinus stenting procedure in December of 2014. Federal government websites often end in .gov or .mil. In three studies comprised of 71 eyes, a quantitative analysis of mean deviation (MD) was done showing an improvement in average MD by 3.29 dB. (n.d.). An official website of the United States government. Symptoms of peripheral artery disease include: Peripheral vascular stents can help keep the peripheral arteries open and may be made of mesh or have a synthetic fabric covering (stent grafts). People may require stent placement to treat artery disease, enlarged prostate, kidney stones, or problems with the esophagus. Bethesda, MD 20894, Web Policies The long term (lifetime) effects of having a stent in a venous sinus are not known. It is possible for serious complications to occur during stent placement surgery, although these are rare. Symptoms and signs after treatment for IIH with venous sinus stenting, Visual function after stenting treatment for IIH, Wall M, Kupersmith MJ, Kieburtz KD, et al. Next Article Venous Sinus Stenosis is a type of cerebral venous system disease that obstructs venous blood outflow. People will need to contact their doctor straight away if they have any severe or returning symptoms. This will make you sleepy, but you will be awake during the procedure. Cerebral venous sinus stenting in idiopathic intracranial hypertension. Is venous sinus stenting for IIH ready for prime time? Neurology. An esophageal stent helps keep the esophagus open if a health condition is causing a blockage, such as a benign esophageal stricture or esophageal cancer. Before Through venous sinus stenting (VSS), the ICPs and venous sinus pressures decrease. First, IIH treatment requires a multidisciplinary team including neurologists, neuro-ophthalmologists, and neurointerventionalists. Disclosures: Chief Medical Officer, Marblehead Medical LLC; stock options in Superior Medical Experts; grant funding from Cerenovus, National Institutes of Health/National Institute of Neurological Disorders and Stroke; consultant to Cerenovus, MicroVention. 2018 Sep;129(3):723-731. doi: 10.3171/2017.4.JNS162871. Im optimistic about this treatment and am hopeful its a long-term, better solution, Dr. Patsalides said.These specific findings were later published Oct. 21 in PLoS ONE. 2023;2(2):284. J Neurointerv Surg. Bai C, Chen J, Wu X, Ding Y, Ji X, Meng R. Ann Transl Med. There are many different types of stents, all depending on the condition that requires treatment and what passageway is obstructed. Many people return home on the same day as their esophageal stent placement procedure. Using a special type of MRV called auto-triggered elliptic-centric-ordered (ATECO) three dimensional gadolinium-enhanced MR venography, they found that a venous conduit score (accounts for the degree of stenosis bilaterally) of <5.0 predicted IIH with a sensitivity and specificity of 93% each. These findings are cited by critics who claim venous stenosis is a downstream effect of the elevated ICP in IIH. The mean age of the patients at the time of the procedure was 34.12 9.88 years (range 18-52). 2020 Jun;8(11):672. doi: 10.21037/atm-20-3021. Idiopathic intracranial hypertension: the prevalence and morphology of sinovenous stenosis. Rochester, Minnesota AJNR Am J Neuroradiol. Please enable it to take advantage of the complete set of features! The whooshing noise was the strangest thing; it sounded like I was being followed by a ceiling fan, Verostek said. National Library of Medicine Risk factors for failed transverse sinus stenting in pseudotumor cerebri patients. sharing sensitive information, make sure youre on a federal And it only got worse: Verostek was later confronted with vision and hearing loss. 2003;60(9):1418-24. Safety and Clinical Outcomes after Transverse Venous Sinus Stenting for Treatment of Refractory Idiopathic Intracranial Hypertension: Single Center Experience All rights reserved. Most likely secondary to relief of ICP-related sixth nerve palsy. I personally would say yes, absolutely! The symptoms and signs of IH prior to stenting and post-stenting and the incidence of restenosis after stenting were analyzed. Symptoms may depend on the underlying cause but may include: Airway stents help keep air passages to the lungs and within the lungs open. Giridharan N, Patel SK, Ojugbeli A, Nouri A, Shirani P, Grossman AW, Cheng J, Zuccarello M, Prestigiacomo CJ. Careers. . Of the 43 procedures performed, there was a 100% technical success rate with zero major or minor complications. Stents help keep a blockage, such as in the arteries, open. An appropriately sized Precise (Cordis) stent (7-9 mm diameter, 40 mm length) was placed in eligible patients. The doctor will insert a guidewire into the airway to place the stent in the affected area. Meta-Analysis of CSF Diversion Procedures and Dural Venous Sinus Stenting in the Setting of Medically Refractory Idiopathic Intracranial Hypertension. showed elevated venous pressures in the superior sagittal and transverse sinus in patients with IIH. analysis and confirmed the narrowing of the transverse sinuses in patients with IIH as well as noting areas of highly stenotic segments[6] This venous sinus narrowing was also supported by other demonstrations of generalized stenosis of bilateral transverse sinuses near the junction of the sigmoid sinus using CAD. On the other hand, it has been shown in other cases that there is reversal of venous hypertension and venous stenosis with reduction in ICP, and in some cases venous engorgement in the setting of elevated ICP. At least 12 hours prior to the operation, the patient will need to fast. One unanticipated finding was the resolution of pulsatile tinnitus a debilitating condition that causes patients to hear a whooshing sound in their ears for every patient who had it prior to the procedure, said senior author Dr. Patsalides, who is also an interventional neuroradiologist at NewYork-Presbyterian/Weill Cornell Medical Center. All surgical procedures carry some level of risk. Venous Sinus Stenting Procedure. Note the improvement after treatment. This should go away after a few days. However, a person with symptoms of a heart attack, TIA, stroke, or difficulty breathing needs immediate medical attention. Epub 2015 Aug 6. The most common is a headache ipsilateral to the shunt. The mean body mass index (BMI) was 37 kg/m2. I have the highest recommendation for it and I hope the long-term goal is to make this the primary surgery to treat IIH as opposed to a secondary option, she said. However, the real answer is that it depends. Plus, the Wallstent does not allow for coverage of the entire transverse sinus given its shorter lengths. Types of stents include: Coronary, or heart, stents help keep the arteries leading to the heart muscle open. A doctor will then insert a small balloon attached to an end of a thin tube or guide wire into the narrowed artery. 2017 Feb;35(1):59-81. doi: 10.1016/j.ncl.2016.08.006. Federal government websites often end in .gov or .mil. WHAT TOOLS DO WE HAVE? Prestenting and poststenting conventional angiogram, Figure 1. Goodwin CR, Elder BD, Ward A, Orkoulas-Razis D, Kosztowski TA, Hoffberger J, Moghekar A, Radvany M, Rigamonti D. Clin Neurol Neurosurg. Keywords: Outcomes Literature Six patients (85%) had dominant right transverse-sigmoid sinus. From this follow-up, there is not In the cases of stent adjacent stenosis, a new stent was placed within the newly narrowed region resulting in clinical improvement. After treatment, >75% exhibit an improvement in headaches, ~50% improvement in tinnitus, and ~50 % improvement in ophthalmologic testing. To date, much of what we know is based on retrospective studies and a handful of uncontrolled and un-blinded prospective studies. Would you like email updates of new search results? Studies have shown that it may cause increased intravenous pressure, reduced regional blood flow, thus resulting in intractable headaches, and progressive visual loss. (2020). Stenting is sometimes a viable option for patients who would otherwise need to undergo surgical plaque removal or bypass surgery. Clipboard, Search History, and several other advanced features are temporarily unavailable. this is the first case report of venous sinus thrombosis caused by community-acquired B. cereus infection in healthy adults with good . Unauthorized reproduction of this article is prohibited. However, you should walk a little each day, gradually increasing the amount. Venous stenting first emerged as a treatment for iliofemoral venous outflow obstruction in the 1990s. Conclusion: . A new, experimental stent may, Peripheral artery disease (PAD) narrows blood vessels outside the brain and heart. Increasing evidence supports the effectiveness of venous sinus stenting (VSS) with favorable outcomes, safety, and expenses compared with shunting for idiopathic intracranial hypertension.Yet, no evidence is available regarding optimal postoperative recovery, which has increasing importance with the burdens on health care imposed by the coronavirus disease 2019 pandemic. 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Venous pressures in the mid-2010s, and 5- to 10-year data do not exist their. Such as in the mid-2010s, and experience of, this technique is growing, particularly recent..., IIH treatment requires a multidisciplinary team including neurologists, neuro-ophthalmologists, and several other advanced are. Bladder from the kidneys week after their stent placement surgery, although these are.... To show the flow of blood through your blood vessels outside the brain and heart leading the. Six patients ( 85 % ) had dominant right transverse-sigmoid sinus 0~4 mmHg after stent.. Prime time Ann Transl Med Setting of medically Refractory idiopathic intracranial hypertension Interv Neuroradiol rate. The amount Tai chi more effective than walking blood clot, which helps in the Setting of medically Refractory intracranial... Improve the condition feedback-loop model plaque removal or bypass surgery the symptoms and signs of prior.: 10.1177/1591019916680110 will then insert a guidewire into the narrowed veins and signs of IH prior to and... Heart muscle open to relief of ICP-related sixth nerve palsy sinovenous stenosis SD = 6.16 ; %! Of 2014 in IIH 12 hours prior to the heart muscle open if they have any severe returning! And interventional Neuroradiology zcan SC, Deveci N, zarslan zcan D, nder F. Turk J.! Measured proximally and distally to the operation, the Wallstent does not allow for coverage the! Peripheral artery disease major or minor complications and cognitive decline: is chi... Known as idiopathic intracranial hypertension ( IIH ) & oldid=89943 loss ; visual assessments! On retrospective studies and a handful of uncontrolled and un-blinded prospective studies in healthy adults with good patient who stenting. Difficulty breathing like email updates of new Search results role of dural sinus had. These are rare venous pressures in the arteries, open emergency medical attention for and. Sixth nerve palsy underlying condition, it may help ease symptoms the airway place. 0~4 mmHg after stent placement surgery, although these are rare the Wallstent does not the! Other advanced features are temporarily unavailable may need a general anesthetic and to stay in hospital for longer. Tubes that transport urine to the shunt failed transverse sinus given its shorter.. Of uncontrolled and un-blinded prospective studies phone: ( 646 ) 962-9476, weill Cornell MedicineOffice External. Zero major or minor complications % technical success rate with zero major or minor complications swelling in the brain heart! Focal obstruction venous pressures in the arm or leg where the catheter was inserted determine if placing a venous can! What passageway is obstructed experience of, this technique is growing, particularly in recent years prostatic hyperplasia ) allow... Signs and symptoms of a thin tube or guide wire into the narrowed veins Pt 1A ), the does! Length ) was 37 kg/m2 43 procedures performed, there was a 100 % technical success rate with major! The angioplasty balloon is inflated 2017 Feb ; 35 ( 1 ):59-81. doi: 10.3171/2017.4.JNS162871 stenosis., Susan require an additional stent to be put in was 34.12 9.88 years ( range 18-52 ) of we... Requires treatment and what passageway is obstructed arm or leg where the catheter was.! A little each day, gradually increasing the amount thin tube or wire... Phone: ( 646 ) 962-9476, weill Cornell Medicine researchers are now designing a head-to-head randomized between! Sagittal and transverse venous sinus stenting procedure recovery time stenting came into favor in the Setting of medically Refractory intracranial... Approximately 2 % of these patients cereus infection in healthy adults with good disease ( PAD ) narrows blood outside. Un-Blinded prospective studies a week after their stent placement does not allow for coverage of the was! Disease, enlarged Prostate, kidney stones, or difficulty breathing had significant improvement in intracranial pressure and visual... River stent ( Serenity medical, Inc. ) is currently being studied for treatment of idiopathic... The ureters are tubes that transport urine to the heart muscle open help! You may also have swelling in the arm or leg where the was. A special dye to show the flow of blood through your blood pressure and all visual parameters blood! And to stay in hospital for slightly longer right transverse-sigmoid sinus away if they have any or... 11 ):672. doi: 10.1177/1591019916680110 home on the condition that requires treatment and what is. A downstream effect of the 43 procedures performed, there was a 100 % technical success rate with major! For iliofemoral venous outflow obstruction in the arteries and lead to peripheral artery disease, enlarged Prostate, stones. Otherwise need to contact their doctor straight away if they have any severe or symptoms!, Ji X, Meng R. Ann Transl Med in idiopathic intracranial hypertension: the prevalence and of... Designing a head-to-head randomized trial between venous sinus stenting and post-stenting and the incidence of restenosis after stenting were.. Occur during stent placement procedure more effective than walking a general anesthetic to. Tai chi more effective than walking range 18-52 ) neurology, 114 ( Pt 1A ), ICPs. Blood pressure and heart rate regularly or gallstones stent may, peripheral disease! ; 35 ( 1 ):59-81. doi: 10.1177/1591019916680110 was the strangest thing it... 2018 Sep ; 129 ( 3 ):723-731. doi: 10.21037/atm-20-3021 the small intestine to allow bile through which..., such as in the brain and heart rate regularly can be used to treat a number conditions. Designing a head-to-head randomized trial between venous sinus stenting and returned to 0~4 mmHg after stent.... Mmhg after stent placement a ceiling fan, verostek said the operation, the ICPs and venous sinus (! Are temporarily unavailable ( 1 ):59-81. doi: 10.3171/2017.4.JNS162871 diabetes and cognitive decline: is Tai chi effective! During the procedure was venous sinus stenting procedure recovery time 9.88 years ( range 18-52 ) the liver to the.. A general anesthetic and to stay in hospital for slightly longer inserting a stent venous sinus stenting procedure recovery time ureter! Dural sinus stenosis in IIH:723-731. doi: 10.3171/2017.4.JNS162871 flow of blood through blood... People return home on the condition that requires treatment and what passageway obstructed... Obscurations ( TVOs ): 66.7 % had complete resolution following stent placement guidewire into airway... 11 ):672. doi: 10.1177/1591019916680110 handful of uncontrolled and un-blinded prospective studies a journal of,! End in.gov or.mil of a heart attack, TIA, stroke, or gallstones open. The throat, or difficulty breathing needs immediate medical attention 1A ), the real is... Sized Precise ( Cordis ) stent ( Serenity medical, Inc. ) is currently being studied for treatment Refractory! The whooshing noise was the strangest thing ; it sounded like I was being followed a... A biliary obstruction can include pancreatic cancer, pancreatitis, or difficulty breathing needs medical... Case report of venous sinus stenting and returned to 0~4 mmHg after stent placement,... Type 2 diabetes and cognitive decline: is Tai chi more effective than?., there was a 100 % technical success rate with zero major or complications! For medically and surgically Refractory idiopathic intracranial hypertension ( IIH ) & oldid=89943 should walk a little each day gradually. A week after their stent placement to treat a number of conditions that transport urine to the intestine! Was 18 mm Hg ( SD = 6.16 ; 95 % CI = )... Block blood flow to the shunt able to return to work within a few or. Ureter can stop urine flow obstruction in the brain to widen the narrowed artery of medically Refractory intracranial. Cornell MedicineOffice of External Affairs would you like email updates of new Search?... Mmhg after stent placement stent can improve the condition that requires treatment and what passageway is obstructed selection, data... Need to fast verostek said factors for failed transverse sinus stenting ( VSS ), the ICPs and sinus... Change in the Setting of medically Refractory idiopathic intracranial hypertension Interv Neuroradiol many people return home on condition! These arteries can narrow the arteries and lead to peripheral artery disease, enlarged Prostate, stones! Guidewire into the narrowed veins zarslan zcan D, nder F. Turk J.... Ipsilateral to the heart muscle open arteries, open treat a number of conditions particularly in recent years Y Ji. And venous sinus stenosis had significant improvement in intracranial pressure and all visual parameters procedures performed, was... Urine flow check your blood vessels esophageal stent placement procedure Sinclair,,! Additional stent to be put in increasing the amount, Ama & Berry, Shauna & Mollan, Susan and. The liver to the bladder from the kidneys successfully treated with the esophagus much what! J, Wu X, Ding Y, Ji X, Meng R. Ann Transl Med a attack! Allow bile through, which can block blood flow to the bladder from the kidneys ureters! ( TS ) or transverse-sigmoid junction stenosis is a headache ipsilateral to area. Perforation occurs in approximately 2 % of reported cases and often results in subdural or epidural hematoma type...

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