Dural sinus septum: an underlying cause of cerebral venous sinus stenting failure and complications.

Objectives: The presence of dural sinus septum has long been identified anatomically but is often neglected for its clinical significance. Our findings revealed the association of dural sinus septum with venous sinus stenting failure and complications supported by clinical evidence.

Methods: This retrospective study included 185 consecutive patients treated with cerebral venous sinus stenting from January 2009 to May 2022. We identified the dural sinus septa using digital subtraction angiography (DSA) and classified them into three types based on their location. The septa at the transverse sinus were defined as type I, those at the junction between the transverse sinus and sigmoid sinus were defined as type II and those at the sigmoid sinus were defined as type III. Based on the anatomic features and neuroimaging clues, we investigated the correlation of dural sinus septa with stenting failure and complications.

Results: 32 (17.1%) out of 185 patients (121 with idiopathic intracranial hypertension and 64 with venous pulsatile tinnitus) were identified with dural sinus septa by DSA. More than half of the septa were type I (18/32, 56.2%), followed by type II (11/32, 34.4%) and type III (3/32, 9.4%). The dural sinus septa caused three stenting failures and complications, including one case of venous sinus injury with subdural haemorrhage and two cases of incomplete stent expansion. Statistical analysis revealed that the presence of dural sinus septum (p<0.01) was associated with complications of cerebral venous sinus stenting.

Discussion: The dural sinus septum is a common structure in the cerebral venous sinus. We found that the presence of dural sinus septa introduces uncertainties to cerebral venous sinus stenting and suggested precautions and ingenious skills in imaging and treatment.