Hemodynamic Evaluation during Balloon Test Occlusion of the Sigmoid Sinus: Clinical and Technical Considerations
Ulrike Ernemanna,
Hubert Löwenheima,
Dirk Freudensteina,
Andrei Koerbela,
Alexandra Heiningerc and
Marcos Tatagibaa
a Department of Neuroradiology, University Hospital Tübingen, Germany
b Department of Otolaryngology-Head and Neck Surgery, University Hospital Tübingen, Germany
c Department of Neurosurgery, University Hospital Tübingen, Germany
d Department of Anesthesiology, University Hospital Tübingen, Germany
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FIG 1. CT, bone window, shows destruction of the right mastoid and cortical bone overlying the sigmoid sinus.
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FIG 2. Postgadolinium axial T1-weighted MR image reveals an enhancing tumor causing substantial compression of the lumen of the sigmoid sinus.
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FIG 3. Right ICA angiogram, frontal projection in the venous phase, demonstrates an 80% stenosis in the proximal part of the dominant right sigmoid sinus.
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FIG 4. Control right ICA angiogram, lateral projection, obtained during test occlusion of the sigmoid sinus with a double-lumen angioplasty balloon inflated with a mixture of contrast agent and saline shows adequate drainage of the vein of Labbé without delay into the transverse sinus.
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FIG 5. Control right ICA angiogram 2 days after permanent occlusion of the sigmoid sinus with a detachable balloon demonstrates patency of the transverse sinus with drainage of the vein of Labbé and jugular bulb via drainage of the inferior petrosal and basilar plexus.
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