The Impact of Dural Venous Sinus Compromise on the Development of Hydrocephalus in Children and Young Adults: A Retrospective Study.

BACKGROUND: The dural venous sinus system (DVSS) plays a central role in cerebral venous drainage and cerebrospinal fluid (CSF) reabsorption. Compromise of the DVSS is traditionally thought to predispose patients to elevated intracranial pressure and hydrocephalus. However, research evaluating this relationship is often scarce.

OBJECTIVE: To determine whether compromise of the DVSS system, especially the superior sagittal sinus, is associated with an increased risk of hydrocephalus in pediatric and young adult patients.

METHODS: We performed a retrospective cohort study (n=62) of pediatric and young adult patients (≤23 years of age) with radiologically confirmed dural venous sinus compromise (sinus thrombosis or stenosis) who were treated within the Montefiore Hospital system from 2016 to 2025. DVSS compromise etiologies included infection, congenital malformations, hypercoagulability/neoplasm, and other causes. Patients were categorized based on the presence or absence of hydrocephalus. Baseline demographics, DVSS sinus involvement, etiology, and clinical outcomes including herniation were analyzed. Group comparisons were performed using appropriate univariate tests. A multivariable logistic regression model evaluated predictors of hydrocephalus, adjusting for age, sex, and herniation.

RESULTS: Sixty-two patients with radiologically confirmed dural venous sinus compromise were identified, of whom 8 (13%) developed hydrocephalus. Patients who developed hydrocephalus were significantly younger than those who did not (mean age 7 vs. 13 years, P=0.024) and were more frequently male (88% vs. 41%, P=0.036). There were no significant differences between groups in the distribution of specific sinus involvement (P=0.418), number of compromised sinus categories (P=0.520), pattern of sinus involvement (P=0.454), or etiology (P=0.966). Herniation occurred more frequently in patients who developed hydrocephalus (38% vs. 9%), though this did not reach statistical significance on univariate analysis (P=0.097). On multivariable logistic regression adjusting for age, sex, and herniation, only herniation was independently associated with hydrocephalus OR 18.22 (95% CI = 1.61-374.76; P=0.029). Age demonstrated a protective trend OR 0.99 (95% CI = 0.97-1.00; P=0.073), while male sex was not independently associated with hydrocephalus OR 5.77 (95% CI = 0.67-129.3; P=0.155).

CONCLUSIONS: In this cohort, hydrocephalus development was not associated with compromise of any dural venous sinus, nor was it associated with the total number of affected dural venous sinuses. Instead, the presence of brain herniation was the only predictor associated with hydrocephalus. Patients with younger age and male sex were associated with hydrocephalus on univariate analysis but did not remain independently significant after adjustment. These findings suggest that compensatory venous and CSF drainage pathways may mitigate the impact of dural venous sinus compromise on hydrocephalus formation in children and young adults. Furthermore, important clinical factors such as age, sex, and brain herniation may play a more critical role in the surgical management of these patients than previously considered. These findings suggest that further investigation with larger studies should be performed to further evaluate the relationship between DVSS compromise and hydrocephalus development.