Endovascular treatment of tumor-related dural sinus stenosis, venous outflow obstruction, and secondary intracranial hypertension: a systematic review of the literature.

Clinical Snapshot

Key Findings

• P Value: Not reported

• Effect Size: Mean trans-stenotic pressure gradient decreased by 10 ± 9 mmHg post-treatment; mean lumbar opening pressure decreased by 11 ± 12 cmH2O

• Primary Outcome: Clinical improvement reported in 63% of patients; papilledema resolution or improvement in 94%; visual change improvement in 94%

• Nnt Or Sensitivity: No NNT calculable — no comparator group. Repeat intervention required in 28% of cases; approximately 50% of those achieved further improvement after reintervention. Zero periprocedural complications reported across 57 patients.

• Confidence Interval: Not reported — descriptive synthesis only, no confidence intervals calculated

Clinical Application

Venous sinus stenting is technically feasible at specialised neurovascular centres with interventional neuroradiology expertise. The procedure requires general anaesthesia, biplane fluoroscopy, and post-procedural antiplatelet therapy. Repeat intervention is required in approximately one-quarter of patients, necessitating ongoing surveillance. The procedure is not widely available outside major tertiary neurosurgical centres. In Australia, venous sinus stenting for idiopathic intracranial hypertension is performed at select quaternary neurovascular centres (e.g., major metropolitan teaching hospitals) but is not universally available. No specific TGA-approved stent indication exists for tumor-related venous sinus stenosis; devices used would be off-label applications of intracranial or venous stent systems. The PBS does not currently list a specific reimbursement pathway for this indication. RACGP and Neuro-Oncology Society of Australia (NOSA) guidelines do not address this specific scenario. Referral to a multidisciplinary neuro-oncology team with interventional neuroradiology capability would be the appropriate pathway. Antiplatelet therapy post-stenting (typically dual antiplatelet for 3–6 months) requires careful consideration in the oncology context, particularly in patients receiving concurrent chemotherapy or at risk of thrombocytopaenia. Highly selected patients with radiologically confirmed tumor-related dural venous sinus stenosis (predominantly meningioma), symptomatic secondary intracranial hypertension (papilledema, visual deterioration, headache), who are either poor surgical candidates or in whom surgical decompression carries prohibitive risk. Mean patient age 48 years; predominantly female (65%), consistent with meningioma demographics.

Abstract

INTRODUCTION: Tumors involving dural venous sinuses can lead to venous outflow obstruction and secondary intracranial hypertension. While surgical resection can decompress the sinus, such procedures carry significant risks. With the success of endovascular interventions for idiopathic intracranial hypertension (IIH), venous sinus stenting (VSS) and angioplasty have emerged as potential treatments for tumor-related sinus stenosis. However, evidence remains limited and dispersed. This systematic review aimed to synthesize the available literature on the safety and efficacy of endovascular treatment for tumor-related venous sinus obstruction. METHODS: A systematic search of PubMed, Embase, and Web of Science was conducted from database inception to November 2025. Eligible studies included any report describing endovascular treatment (VSS and/or angioplasty) for tumor-related venous sinus obstruction, whether due to tumor invasion or compression, or even stenosis following surgery or radiotherapy. Data on patient demographics, tumor characteristics, procedural details, and outcomes were extracted and summarized descriptively. RESULTS: Twenty studies comprising 57 patients were included. Most patients were female (65%) with a mean age of 48 years. Meningioma represented the most common underlying tumor (75%). The majority of obstructions resulted from tumor compression or invasion (86%), and most patients underwent VSS alone (74%), while the rest underwent VSS and angioplasty (23%). No periprocedural complications were reported. Mean trans-stenotic pressure gradient decreased by 10 ± 9 mmHg post-treatment and mean lumbar opening pressure decreased by 11 ± 12 cmH2O. Clinical improvement was reported in 63% of patients, including resolution or improvement of papilledema in 94% and vision changes in 94%. Repeat intervention was required in 28% of cases, and only about half of patients achieved further improvement after reintervention. CONCLUSION: Endovascular therapy for tumor-related venous sinus stenosis appears safe and effective, leading to meaningful pressure reduction and symptomatic improvement in two-thirds of patients. These findings support VSS as a viable adjunct or alternative to surgery in selected patients. Nonetheless, the certainty of evidence remains very low, and current data cannot establish definitive conclusions.

References

1. 1.El-Hajj, V. G., Gharios, M., Roy, J. M., Musmar, B., Carey, P., Mualem, W., Chanbour, H., Feghali, J., Naik, A., Staartjes, V. E., Elmi-Terander, A., Atallah, E., Alshahrani, R., Mouchtouris, N., Rosenwasser, R. H., Tjoumakaris, S., Gooch, M. R., & Jabbour, P. (2026). Endovascular treatment of tumor-related dural sinus stenosis, venous outflow obstruction, and secondary intracranial hypertension: a systematic review of the literature. Journal of Neuro-Oncology. https://doi.org/10.1136/jnis-2022-019844