Venous Sinus Stenosis: Causes, Risk Factors, and When to See a Neurosurgeon

April 28th, 2025 by New Jersey Brain and Spine

Venous sinus stenosis refers to the narrowing of the large veins that transport blood from the brain to the heart, called the venous sinuses. This narrowing obstructs normal blood flow and increases pressure in the skull. When left untreated, venous sinus stenosis can lead to headaches, vision changes, a pulsating buzzing in the ear, and in some cases, more serious neurological problems. The most significant complication is the formation of blood clots.

Due to the complex nature of venous sinus stenosis and its potential complications, specialty expertise and care are essential for accurate diagnosis and effective treatment.

What causes venous sinus stenosis?

Venous sinus stenosis can be caused by a variety of factors including:

Enlarged arachnoid granulations: These are valves that allow cerebrospinal fluid to flow through the venous sinuses from the brain to the blood stream. When they enlarge, they narrow the passage.
Fibrous septae: Scar tissue can develop within the venous sinus and restrict blood flow.
Increased intracranial pressure: In injuries to the head or conditions that cause an increase in intracranial pressure, the venous sinuses may collapse against the skull, restricting blood flow.
Tumors: Growths that develop in or near the venous sinuses can compress the area.
Infections: Inflammation caused by conditions like meningitis can cause swelling that affects the venous sinuses.

Leaving venous sinus stenosis untreated can lead to serious complications. The most significant is the development of blood clots, called venous sinus thrombosis, which can cause brain swelling, bleeding, or stroke. While rare, children with the following conditions have a higher risk for venous sinus thrombosis:

Blood clotting disorders
Sickle cell anemia
Chronic hemolytic anemia
Beta-thalassemia major
Congenital heart disease
Iron deficiency

Risk factors for adults include:

Pregnancy and postpartum period
Blood clotting disorders
Chronic inflammatory bowel diseases
Cancer
Obesity
Intracranial hypotension

Symptoms of venous sinus stenosis

Symptoms of venous sinus stenosis can vary and mimic other conditions. Common signs include:

Ongoing headaches
Visual disturbances, such as blurred vision or double vision
Tinnitus (ringing in the ears)
Dizziness or vertigo
Nausea and vomiting
Mental confusion or memory problems
Weakness or numbness in part of the body

Diagnosis and treatment

Diagnosing venous sinus stenosis involves a clinical evaluation and advanced imaging techniques. There are three techniques that may be used alone or in combination to make an accurate diagnosis.

Magnetic resonance venography (MRV) uses magnetic fields and radio waves to create detailed images of the blood vessels in the brain, helping to identify any narrowing of the venous sinuses.

Computed tomography venography (CTV) is a non-invasive procedure during which a contrast dye is injected directly into the bloodstream, making the veins more visible on a CT scan.

Cerebral angiography is a procedure where a surgeon inserts a catheter (small, flexible tube) into an artery in the groin and threaded through the vessels up to the brain. A contrast dye is then injected into the catheter to obtain high-resolution images of the brain’s blood vessels.

Once venous sinus stenosis is diagnosed, treatment will depend on the symptoms and their severity. In some cases, medications such as anticoagulants or anti-inflammatory drugs may be prescribed to manage symptoms and prevent complications.

For more severe cases, venous sinus stenting may be performed. This involves placing a small mesh tube, or stent, into the narrowed section of the venous sinus to keep it open and improve blood flow. In rare cases, surgical intervention may be necessary to remove the cause of the venous sinus stenosis to restore normal blood flow.

When to seek care

While untreated stenosis can lead to serious complications, including vision loss in rare cases, many patients can experience complete resolution of symptoms when treated appropriately.

Timely diagnosis and treatment is critical to prevent complications and improve outcomes.

If you experience persistent headaches, visual disturbances, or any other concerning symptoms related to venous sinus stenosis, especially if they do not improve with rest and over-the-counter medication, contact the specialists at New Jersey Brain and Spine.

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