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Neurologic complications of petrosal sinus sampling

D L Miller1, J L Doppman, S B Peterman

  • 1Diagnostic Radiology Department, Warren Grant Magnuson Clinical Center, Bethesda, MD.

Radiology
|October 1, 1992
PubMed

Insights

Petrosal sinus sampling, though generally safe, can cause brain stem injury. Early detection of subtle symptoms and prompt catheter withdrawal can prevent serious neurologic complications.

Area of Science:

  • Neurology
  • Interventional Radiology
  • Vascular Medicine

Background:

  • Petrosal sinus sampling is a diagnostic procedure often considered low-risk.
  • The procedure involves accessing the petrosal sinuses, typically for hormonal assessment.

Observation:

  • Two cases of brain stem injury following petrosal sinus sampling are reported.
  • Two additional cases where brain stem injury was successfully avoided are also presented.
  • Major neurologic complications occurred in 0.2% of 508 procedures at NIH, and 0.5% with a specialized catheter.

Findings:

  • The exact cause of brain stem injury is unknown but suspected to be localized venous hypertension.
  • Tip-deflector catheter-guide-wire systems are recommended for petrosal sinus sampling.
  • No other catheter type can be definitively recommended due to insufficient data.

Implications:

  • Brain stem injury during petrosal sinus sampling is preventable.
  • Prompt catheter withdrawal upon the earliest sign of any issue, even subtle, is crucial.
  • Subtle or seemingly non-neurologic symptoms may precede severe clinical events and must be heeded.

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