The Asia-Pacific Journal of Ophthalmology

Asia-Pacific Journal of Ophthalmology:

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Diagnosis and Management of Cerebral Venous Diseases in Neuro-Ophthalmology: Ongoing Controversies

Dinkin, Marc; Patsalides, Athos; Ertel, Monica



Author Information


From the *Department of Ophthalmology; †Department of Neurology; and ‡Department of Neurosurgery, Weill Cornell Medical College, New York, United States.


Reprints: Marc Dinkin, Departments of Ophthalmology and Neurology, Weill Cornell Medical College, New York Presbyterian Hospital, 1305 York Avenue, 11th Floor, New York, NY 10065. 
E-mail: mjd2004@med.cornell.edu.



Abstract


Diseases of the cerebral venous system frequently lead to neuro-ophthalmic complications. Cortical venous sinus thrombosis and dural arteriovenous fistulas may be complicated by elevation of intracranial pressure, with secondary papilledema or abducens palsies. There is increasing recognition that stenosis at the transverse sinus–sigmoid sinus junction plays a role in the pathophysiology of idiopathic intracranial hypertension and offers a new avenue of treatment in patients who fail medical therapy. Diseases of the cavernous sinus manifest with their own set of neuro-ophthalmic symptoms, reflecting the presence of all 3 ocular motor nerves and the oculosympathetic fibers within its walls, along with its role as the primary drainage pool of the globe and orbit. Numerous questions and controversies remain regarding the diagnosis and optimal treatment of cerebral venous disease, including the role of venous stenting in idiopathic intracranial hypertension, the role of anticoagulation in cavernous sinus thrombosis, and the risks and benefits of embolization of mild indirect cavernous carotid fistulas.




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