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<meta name="og-description" property="og:description" content="SUMMARY: Arachnoid granulations may expand the dural sinuses or inner table of the skull. Although usually incidental, giant arachnoid granulations that are of sufficient size to fill the lumen of a dural sinus and cause local dilation or filling defects can rarely cause symptoms due to sinus obstruction leading to venous hypertension. This 31-year-old man presented with a 3-month history of progressive bifrontal headaches and a giant arachnoid granulation at the posterior superior sagittal sinus. Intrasinus pressure measurements showed no significant pressure difference across the lesion to explain the headaches, which were then treated medically. Dural sinus pressure measurement, in certain cases of giant arachnoid granulations, can be used to exclude the lesion as the cause of the patient’s symptoms." />
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      <h1 class="highwire-cite-title" id="page-title">Incidental Giant Arachnoid Granulation</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">P. Kan</span>, <span class="highwire-citation-author" data-delta="1">E.A. Stevens</span> and <span class="highwire-citation-author" data-delta="2">W.T. Couldwell</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">August 2006,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">27 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(7) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1491-1492; </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-7206--62030419520" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">P. Kan </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=P.%2BKan%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Kan%20P&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AP.%2BKan%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">E.A. Stevens </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=E.A.%2BStevens%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Stevens%20E&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AE.A.%2BStevens%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">W.T. Couldwell </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=W.T.%2BCouldwell%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Couldwell%20W&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AW.T.%2BCouldwell%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div></div></div>  </div>

  
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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" data-highwire-cite-ref-tooltip-instance="highwire_reflinks_tooltip" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="article fulltext-view"><span class="highwire-journal-article-marker-start"></span><div class="section abstract" id="abstract-1"><h2>Abstract</h2><p id="p-1"><strong>SUMMARY:</strong> Arachnoid granulations may expand the dural sinuses or inner table of the skull. Although usually incidental, giant arachnoid granulations that are of sufficient size to fill the lumen of a dural sinus and cause local dilation or filling defects can rarely cause symptoms due to sinus obstruction leading to venous hypertension. This 31-year-old man presented with a 3-month history of progressive bifrontal headaches and a giant arachnoid granulation at the posterior superior sagittal sinus. Intrasinus pressure measurements showed no significant pressure difference across the lesion to explain the headaches, which were then treated medically. Dural sinus pressure measurement, in certain cases of giant arachnoid granulations, can be used to exclude the lesion as the cause of the patient’s symptoms.</p></div><p id="p-2">Arachnoid granulations are growths of arachnoid membrane into the dural sinuses through which CSF enters the venous system.<sup><a id="xref-ref-1-1" class="xref-bibr" href="#ref-1">1</a></sup> They normally measure a few millimeters but may grow to fill and dilate the dural sinuses or expand the inner table of the skull.<sup><a id="xref-ref-1-2" class="xref-bibr" href="#ref-1">1</a>–<a id="xref-ref-3-1" class="xref-bibr" href="#ref-3">3</a></sup> They are often discovered as incidental findings in the transverse and posterior superior sagittal sinus,<sup><a id="xref-ref-1-3" class="xref-bibr" href="#ref-1">1</a>–<a id="xref-ref-3-2" class="xref-bibr" href="#ref-3">3</a></sup> though they have rarely been reported to cause symptoms from venous hypertension secondary to partial sinus occlusion.<sup><a id="xref-ref-2-1" class="xref-bibr" href="#ref-2">2</a></sup> We present a case of a patient who presented with progressive headaches and a giant arachnoid granulation involving his posterior superior sagittal sinus. Intrasinus pressure measurements across the lesion were performed to exclude the lesion as the cause of the patient’s symptoms.</p><div class="section" id="sec-1"><h2>Case Report</h2><p id="p-3">A 31-year-old man presented with a 3-month history of progressive bifrontal headaches. Neurologic examination revealed normal visual fields and acuity. Funduscopic examination showed sharp disk margins. Imaging studies including CT, MR imaging, and CT angiography were performed. Findings demonstrated a giant arachnoid granulation in the posterior third of the superior sagittal sinus, expanding the surrounding inner table (<a id="xref-fig-1-1" class="xref-fig" href="#F1">Fig 1<em>A, -B</em></a>). Lumbar puncture was performed, demonstrating clear CSF with no pleocytosis. Opening pressure was high normal. Because of the possibility of relative venous obstruction producing venous hypertension and headaches, cerebral angiography was performed. The venous phase of the angiogram revealed an enlarged superior sagittal sinus involving the posterior third of the sinus, with an apparent filling defect dividing into 3 separate channels that flowed around the filling defect and reconstituted distally (<a id="xref-fig-2-1" class="xref-fig" href="#F2">Fig 2<em>A</em></a>). Intrasinus pressure measurements showed no evidence of significant pressure difference across the lesion within all 3 dural venous limbs to account for the patient’s symptoms (<a id="xref-fig-2-2" class="xref-fig" href="#F2">Fig 2<em>B</em></a>). The headaches were treated symptomatically with medical therapy.</p><div id="F1" class="fig pos-float odd"><div class="highwire-figure"><div class="fig-inline-img-wrapper"><div class="fig-inline-img"><a href="http://ajnr-stage2.stage.highwire.org/content/ajnr/27/7/1491/F1.large.jpg?width=800&amp;height=600&amp;carousel=1" title="Axial (A) and sagittal (B) CT angiograms show a giant arachnoid granulation in the posterior superior sagittal sinus (arrow). In B, the expansion of the inner skull table is visible." class="highwire-fragment fragment-images colorbox-load" rel="gallery-fragment-images-1760414555" data-figure-caption="&lt;div class=&quot;highwire-markup&quot;&gt;Axial (A) and sagittal (B) CT angiograms show a giant arachnoid granulation in the posterior superior sagittal sinus (arrow). In B, the expansion of the inner skull table is visible.&lt;/div&gt;" data-icon-position="" data-hide-link-title="0"><span class="hw-responsive-img"><img class="highwire-fragment fragment-image lazyload" alt="Fig. 1." src="data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7" data-src="http://ajnr-stage2.stage.highwire.org/content/ajnr/27/7/1491/F1.medium.gif" width="440" height="204"/><noscript><img class="highwire-fragment fragment-image" alt="Fig. 1." src="http://ajnr-stage2.stage.highwire.org/content/ajnr/27/7/1491/F1.medium.gif" width="440" height="204"/></noscript></span></a></div></div><ul class="highwire-figure-links inline"><li class="download-fig first"><a href="http://ajnr-stage2.stage.highwire.org/content/ajnr/27/7/1491/F1.large.jpg?download=true" class="highwire-figure-link highwire-figure-link-download" title="Download Fig. 1." data-icon-position="" data-hide-link-title="0">Download figure</a></li><li class="new-tab"><a href="http://ajnr-stage2.stage.highwire.org/content/ajnr/27/7/1491/F1.large.jpg" class="highwire-figure-link highwire-figure-link-newtab" target="_blank" data-icon-position="" data-hide-link-title="0">Open in new tab</a></li><li class="download-ppt last"><a href="/highwire/powerpoint/22485" class="highwire-figure-link highwire-figure-link-ppt" data-icon-position="" data-hide-link-title="0">Download powerpoint</a></li></ul></div><div class="fig-caption" xmlns:xhtml="http://www.w3.org/1999/xhtml"><span class="fig-label"><strong>Fig. 1.</strong></span> <p id="p-8" class="first-child">Axial (<em>A</em>) and sagittal (<em>B</em>) CT angiograms show a giant arachnoid granulation in the posterior superior sagittal sinus (<em>arrow</em>). In <em>B</em>, the expansion of the inner skull table is visible.</p><div class="sb-div caption-clear"></div></div></div><div id="F2" class="fig pos-float odd"><div class="highwire-figure"><div class="fig-inline-img-wrapper"><div class="fig-inline-img"><a href="http://ajnr-stage2.stage.highwire.org/content/ajnr/27/7/1491/F2.large.jpg?width=800&amp;height=600&amp;carousel=1" title="A, Angiogram shows the superior sagittal sinus (arrow) dividing into 3 separate channels that flow around the filling defect and reconstitute distally. B, Angiogram of the superior sagittal sinus shows a microcatheter (arrow) traversing through the right venous channel to measure pressure across the lesion within the right venous channel." class="highwire-fragment fragment-images colorbox-load" rel="gallery-fragment-images-1760414555" data-figure-caption="&lt;div class=&quot;highwire-markup&quot;&gt;A, Angiogram shows the superior sagittal sinus (arrow) dividing into 3 separate channels that flow around the filling defect and reconstitute distally. B, Angiogram of the superior sagittal sinus shows a microcatheter (arrow) traversing through the right venous channel to measure pressure across the lesion within the right venous channel.&lt;/div&gt;" data-icon-position="" data-hide-link-title="0"><span class="hw-responsive-img"><img class="highwire-fragment fragment-image lazyload" alt="Fig. 2." src="data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7" data-src="http://ajnr-stage2.stage.highwire.org/content/ajnr/27/7/1491/F2.medium.gif" width="440" height="307"/><noscript><img class="highwire-fragment fragment-image" alt="Fig. 2." src="http://ajnr-stage2.stage.highwire.org/content/ajnr/27/7/1491/F2.medium.gif" width="440" height="307"/></noscript></span></a></div></div><ul class="highwire-figure-links inline"><li class="download-fig first"><a href="http://ajnr-stage2.stage.highwire.org/content/ajnr/27/7/1491/F2.large.jpg?download=true" class="highwire-figure-link highwire-figure-link-download" title="Download Fig. 2." data-icon-position="" data-hide-link-title="0">Download figure</a></li><li class="new-tab"><a href="http://ajnr-stage2.stage.highwire.org/content/ajnr/27/7/1491/F2.large.jpg" class="highwire-figure-link highwire-figure-link-newtab" target="_blank" data-icon-position="" data-hide-link-title="0">Open in new tab</a></li><li class="download-ppt last"><a href="/highwire/powerpoint/22440" class="highwire-figure-link highwire-figure-link-ppt" data-icon-position="" data-hide-link-title="0">Download powerpoint</a></li></ul></div><div class="fig-caption"><span class="fig-label"><strong>Fig. 2.</strong></span> <p id="p-9" class="first-child"><em>A</em>, Angiogram shows the superior sagittal sinus (<em>arrow</em>) dividing into 3 separate channels that flow around the filling defect and reconstitute distally. <em>B</em>, Angiogram of the superior sagittal sinus shows a microcatheter (<em>arrow</em>) traversing through the right venous channel to measure pressure across the lesion within the right venous channel.</p><div class="sb-div caption-clear"></div></div></div></div><div class="section" id="sec-2"><h2>Discussion</h2><p id="p-4">Arachnoid granulations or villi are growths of arachnoid membrane into the dural sinuses, through which the CSF enters the venous system from the subarachnoid space.<sup><a id="xref-ref-1-4" class="xref-bibr" href="#ref-1">1</a></sup> Arachnoid villi are microscopic, whereas arachnoid granulations represent distended villi and are visible to the naked eye.<sup><a id="xref-ref-4-1" class="xref-bibr" href="#ref-4">4</a></sup> Arachnoid granulations increase in numbers and enlarge with age in response to increased CSF pressure from the subarachnoid space and are usually quite apparent by 4 years of age.<sup><a id="xref-ref-5-1" class="xref-bibr" href="#ref-5">5</a>,<a id="xref-ref-6-1" class="xref-bibr" href="#ref-6">6</a></sup> They normally measure a few millimeters but may grow to expand the inner table of the skull, most commonly around midline in the posterior frontal or anterior parietal area.<sup><a id="xref-ref-7-1" class="xref-bibr" href="#ref-7">7</a></sup> Occasionally, they even expand into the diploic space and eventually involve the outer table, mimicking osteolytic lesions.<sup><a id="xref-ref-6-2" class="xref-bibr" href="#ref-6">6</a>–<a id="xref-ref-8-1" class="xref-bibr" href="#ref-8">8</a></sup> Although there is no consensus in the literature, we refer to arachnoid granulations as “giant” when they are of sufficient size to fill the lumen of a dural sinus and cause local dilation or filling defects.</p><p id="p-5">Although they are often discovered as incidental findings in the transverse and posterior superior sagittal sinus,<sup><a id="xref-ref-1-5" class="xref-bibr" href="#ref-1">1</a>–<a id="xref-ref-3-3" class="xref-bibr" href="#ref-3">3</a></sup> they can grow to fill and dilate the dural sinuses, causing symptoms of increased intracranial pressure from venous hypertension secondary to partial sinus occlusion.<sup><a id="xref-ref-2-2" class="xref-bibr" href="#ref-2">2</a></sup> In our patient, the lesion appeared to impinge on the posterior third of the superior sagittal sinus. To determine whether the lesion was causing venous outflow obstruction and venous hypertension, we performed intrasinus pressure measurements across the lesion through each dural channel. In patients with pseudotumor with venous sinus obstruction as the cause of increased intracranial pressure, the proximal venous pressure was found to be as high as 36 mm Hg, with a corresponding pressure gradient of 25 mm Hg.<sup><a id="xref-ref-9-1" class="xref-bibr" href="#ref-9">9</a></sup> The presence of normal venous pressures (<em>∼</em>15 mm Hg) and the lack of significant differential pressure across the lesion within all dural venous limbs (&lt;<em>5</em> mm Hg) in our patient ruled out venous hypertension and excluded the lesion as the cause of the patient’s symptoms.</p><p id="p-6">Imaging of giant arachnoid granulations is often suggestive of partial sinus occlusion. Although largely incidental, giant arachnoid granulations can rarely cause symptoms due to sinus obstruction leading to venous hypertension. Dural sinus pressure measurement across the lesion is a novel and valuable approach to determine if the lesion is symptomatic because of venous obstruction and hypertension. Normal venous pressure with no significant differential pressure across the lesion can safely exclude the lesion as the cause of the patient’s symptoms.</p></div><div class="section ack" id="ack-1"><h2>Acknowledgments</h2><p id="p-7">We thank Kristin Kraus for her editorial assistance in preparing this manuscript.</p></div><div class="section ref-list" id="ref-list-1"><h2>References</h2><ol class="cit-list"><li><a class="rev-xref-ref" href="#xref-ref-1-1" title="View reference 1 in text" id="ref-1">↵</a><div class="cit ref-cit ref-other" id="cit-27.7.1491.1" data-doi="10.1007/s002340050564"><div class="cit-metadata"><cite>Chin SC, Chen CY, Lee CC, et al. <strong>Giant arachnoid granulation mimicking dural sinus thrombosis in a boy with headache: MRI.</strong> <span class="cit-source">Neuroradiology</span> <span class="cit-pub-date">1998</span>;<span class="cit-vol">40</span>:<span class="cit-fpage">181</span>–83</cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1007/s002340050564&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=9561525&amp;link_type=MED&amp;atom=%2Fajnr%2F27%2F7%2F1491.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-2-1" title="View reference 2 in text" id="ref-2">↵</a><div class="cit ref-cit ref-other" id="cit-27.7.1491.2" data-doi="10.1136/jnnp.74.4.418"><div class="cit-metadata"><cite>Arjona A, Delgado F, Fernandez-Romero E. <strong>Intracranial hypertension secondary to giant arachnoid granulations.</strong> <span class="cit-source">J Neurol Neurosurg Psychiatry</span> <span class="cit-pub-date">2003</span>;<span class="cit-vol">74</span>:<span class="cit-fpage">418</span></cite></div><div class="cit-extra"><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiam5ucCI7czo1OiJyZXNpZCI7czo4OiI3NC80LzQxOCI7czo0OiJhdG9tIjtzOjIwOiIvYWpuci8yNy83LzE0OTEuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-3-1" title="View reference 3 in text" id="ref-3">↵</a><div class="cit ref-cit ref-other" id="cit-27.7.1491.3"><div class="cit-metadata"><cite>Mamourian AC, Towfighi J. <strong>MR of giant arachnoid granulation: a normal variant presenting as a mass within the dural venous sinus.</strong> <span class="cit-source">AJNR Am J Neuroradiol</span> <span class="cit-pub-date">1995</span>;<span class="cit-vol">16</span>:<span class="cit-fpage">901</span>–04</cite></div><div class="cit-extra"><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiYWpuciI7czo1OiJyZXNpZCI7czo4OiIxNi80LzkwMSI7czo0OiJhdG9tIjtzOjIwOiIvYWpuci8yNy83LzE0OTEuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span></span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-4-1" title="View reference 4 in text" id="ref-4">↵</a><div class="cit ref-cit ref-other" id="cit-27.7.1491.4" data-doi="10.1148/105.2.333"><div class="cit-metadata"><cite>Potts DG, Reilly KF, Deonarine V. <strong>Morphology of the arachnoid villi and granulations.</strong> <span class="cit-source">Radiology</span> <span class="cit-pub-date">1972</span>;<span class="cit-vol">105</span>:<span class="cit-fpage">333</span>–41</cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1148/105.2.333&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=5079659&amp;link_type=MED&amp;atom=%2Fajnr%2F27%2F7%2F1491.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-5-1" title="View reference 5 in text" id="ref-5">↵</a><div class="cit ref-cit ref-other" id="cit-27.7.1491.5"><div class="cit-metadata"><cite>LeGross Clark WE. <strong>On the pacchionian granulations.</strong> <span class="cit-source">J Anat</span> <span class="cit-pub-date">1920</span>;<span class="cit-vol">55</span>:<span class="cit-fpage">40</span>–48</cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=17103914&amp;link_type=MED&amp;atom=%2Fajnr%2F27%2F7%2F1491.atom" class="cit-ref-sprinkles 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7 in text" id="ref-7">↵</a><div class="cit ref-cit ref-other" id="cit-27.7.1491.7"><div class="cit-metadata"><cite>Branan R, Wilson CB. <strong>Arachnoid granulations simulating osteolytic lesions of the calvarium.</strong> <span class="cit-source">AJR Am J Roentgenol</span> <span class="cit-pub-date">1976</span>;<span class="cit-vol">127</span>:<span class="cit-fpage">523</span>–25</cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=183547&amp;link_type=MED&amp;atom=%2Fajnr%2F27%2F7%2F1491.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-8-1" title="View reference 8 in text" id="ref-8">↵</a><div class="cit ref-cit ref-other" id="cit-27.7.1491.8"><div class="cit-metadata"><cite>[No authors listed] <strong>Case records of the Massachusetts General Hospital: weekly clinicopathological exercises. Case 42-1984. A 29-year-old woman with a lytic lesion of a parietal bone.</strong> <span class="cit-source">N Engl J Med</span> <span class="cit-pub-date">1984</span>;<span class="cit-vol">311</span>:<span class="cit-fpage">1036</span>–43</cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=6482911&amp;link_type=MED&amp;atom=%2Fajnr%2F27%2F7%2F1491.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-9-1" title="View reference 9 in text" id="ref-9">↵</a><div class="cit ref-cit ref-other" id="cit-27.7.1491.9"><div class="cit-metadata"><cite>Owler BK, Parker G, Halmagyi GM, et al. <strong>Pseudotumor cerebri syndrome: venous sinus obstruction and its treatment with stent placement.</strong> <span class="cit-source">J Neurosurg</span> <span class="cit-pub-date">2003</span>;<span class="cit-vol">98</span>:<span class="cit-fpage">1045</span>–55</cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=12744365&amp;link_type=MED&amp;atom=%2Fajnr%2F27%2F7%2F1491.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li></ol></div><ul class="history-list"><li xmlns:hwp="http://schema.highwire.org/Journal" class="received" hwp:start="2005-06-17"><span class="received-label">Received </span>June 17, 2005.</li><li xmlns:hwp="http://schema.highwire.org/Journal" class="accepted" hwp:start="2005-08-21"><span class="accepted-label">Accepted after revision </span>August 21, 2005.</li></ul><ul class="copyright-statement"><li class="fn" id="copyright-statement-1">Copyright © American Society of Neuroradiology</li></ul><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div><a href="http://ajnr-stage2.stage.highwire.org/content/27/7/1491.abstract" class="hw-link hw-link-article-abstract" data-icon-position="" data-hide-link-title="0">View Abstract</a></div>  </div>

  
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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 27</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 7 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">August 2006 </div></div>
      
      
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    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">P.</span> <span class="nlm-surname">Kan</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">E.A.</span> <span class="nlm-surname">Stevens</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">W.T.</span> <span class="nlm-surname">Couldwell</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Aug 2006, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">27 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(7) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1491-1492; </span></div>
  
  
  
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    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">P.</span> <span class="nlm-surname">Kan</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">E.A.</span> <span class="nlm-surname">Stevens</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">W.T.</span> <span class="nlm-surname">Couldwell</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Aug 2006, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">27 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(7) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1491-1492; </span></div>
  
  
  
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