Epstein-Barr virus-associated smooth muscle tumor partially occluding the superior sagittal sinus: illustrative case.

Background: Venous sinus-occlusive mass lesions are infrequent and commonly include meningiomas, with Epstein-Barr virus-associated smooth muscle tumor (EBV-SMT) being much less common.

Observations: The authors present a case report of a venous sinus-occlusive EBV-SMT in an adolescent immunosuppressed male after liver transplantation.

Lessons: The case highlights the importance of considering blood flow dynamics and the use of advanced imaging modalities including incident dark field microcirculation microscopy and indocyanine green video angiography when managing venous sinus-occlusive mass lesions. To the best of the authors' knowledge, this is the first report of a primary intracranial venous sinus EBV-SMT occurring in an HIV-negative patient after liver transplantation, and it illustrates management dilemmas of a sinus-occlusive tumor at a sensitive region of the superior sagittal sinus. https://thejns.org/doi/10.3171/CASE24759.