Balloon protection of the Labbe vein during venous sinus stenting

Background: Endovascular treatment of dural venous sinus stenosis using auto-expandable stents is progressively becoming a central part in the management of patients with idiopathic intracranial hypertension (IIH) and pulsatile tinnitus. One potential concern during stenting is impairment of venous outflow in the Labbé vein, which usually drains in close proximity to the culprit transverse sinus stenosis. Methods: We propose a technique which can counteract venous outflow impairment, consisting of temporary balloon protection of the Labbé vein during stent deployment. Results: We illustrate the use of this technique in a case of IIH with intrinsic dural sinus stenosis induced by a large arachnoid granulation situated close to the insertion of the Labbé vein. The stent was deployed under temporary balloon inflation in order to deflect the arachnoid granulation away from the vein ostium. Conclusions: In selected cases of intrinsic stenosis, temporary balloon protection can be used to avoid Labbé vein flow impairment during venous sinus stenting.