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Description
Purpose: To investigate the interrelationship between body mass index (BMI), venous sinus pressure (VSP), and craniospinal elastance in determining lumbar puncture opening pressure (LP OP) in idiopathic intracranial hypertension (IIH).
Methods: A single-center retrospective chart review was conducted to identify patients who received venous manometry (8/2021-11/2025) followed by LP within 7 days before stenting. VSPs were measured at standardized locations, including the torcula (TP) and sigmoid/jugular (SIJ) sinuses. Elastance was calculated as (OP – closing pressure)/volume of CSF removed. Statistical analysis (JASP 0.19.3) was performed using generalized linear model (Gaussian identity; scaled center) to assess relationships between LP OP, BMI, TP, elastance, and BMI×elastance interaction while controlling for age and sex, with random intercept, and hierarchical removal of interaction terms.
Results: Of 135 screened patients, 28 refractory IIH patients (92.9% female; BMI 38.2±9.5) met criteria. Racial distribution included 50.0% Caucasian, 39.3% African American, and 10.7% other groups. Mean LP OP was 32.7±14.1cmH₂O; mean TP 30.0±15.8mmHg; mean SIJ 15.6±6.5mmHg; and mean elastance 0.784±0.377cmH₂O/mL. TP, elastance, and the BMI×elastance interaction were significant predictors of LP OP. Notably, BMI’s effect on LP OP became significantly stronger as elastance increased.
Conclusions: These findings suggest that craniospinal elastance modulates how BMI contributes to intracranial pressure elevation in IIH, providing a potential explanation for heterogeneity in pressure responses among patients with similar BMI. Patients with elevated elastance may be particularly vulnerable to BMI-related pressure increases. Larger prospective studies are needed to validate these interactions and clarify their relevance to IIH pathophysiology and clinical management.
Publication Date
2-2-2026
Keywords
idiopathic intracranial hypertension, venous manometry, diagnosis, body mass index, craniospinal elastance
Disciplines
Medicine and Health Sciences | Neurology | Neurosurgery
Recommended Citation
Wang, BA, BS, Rachel; Keith, PhD, Scott W.; Jabbour, MD, Pascal M.; Tjoumakaris, MD, Stavropoula I.; Marmura, MD, Michael J.; Gooch, MD, Michael R.; and Yuan, MD, PhD, Hsiangkuo, "Interrelationship between Body Mass Index, Venous Sinus Pressures, Craniospinal Elastance, and Intracranial Pressure In Idiopathic Intracranial Hypertension" (2026). Alpha Omega Alpha Research Symposium Posters. 28.
https://jdc.jefferson.edu/aoa_research_symposium_posters/28
Comments
Presented at the 2026 AOA Research Symposium.