What question did this study set out to answer?

This study investigates the feasibility of balloon-assisted occlusion to enhance visualization of cerebral venous anatomy during retrograde cerebral venography.

July 12, 2026Open Access

Balloon-assisted retrograde cerebral venography for enhanced visualization of the posterior and lateral dural venous sinuses: a feasibility study

WAWarda AhmedAga Khan University OGOm H. GandhiUniversity of Pennsylvania SASami AlmasriRoyal College of Surgeons in Ireland

Key Points

This study investigates the feasibility of balloon-assisted occlusion to enhance visualization of cerebral venous anatomy during retrograde cerebral venography.
Included 17 consecutive patients undergoing balloon-assisted RCV.
A 9 F balloon guide catheter was positioned in the internal jugular vein or sigmoid sinus.
Visualization quality was assessed by three neuroradiologists before and after balloon inflation.
Balloon inflation increased 'well visualized' pathology rates from 15.7% to 88.2% (p < 0.001, OR = 29.04).
The most distant structure visible shifted from the ipsilateral sigmoid sinus (45.1%) to the contralateral sigmoid sinus (72.5%) with balloon occlusion (p < 0.001).
Significant improvements in homogeneous opacification and margin delineation of transverse and sigmoid sinuses (p < 0.001).

Abstract

Abstract Purpose The venous phase of DSA offers inferior spatial resolution of cerebral venous anatomy due to contrast dilution. Likewise, retrograde cerebral venography (RCV) suffers from poor contrast retention due to contrast injection opposing the physiological direction of venous drainage. Therefore, this study aims to investigate the feasibility of balloon-assisted occlusion in improving visualization of cerebral venous anatomy during RCV. Methods 17 consecutive patients who underwent balloon-assisted RCV between September 2023-June 2025 were included. A 9 F balloon guide catheter was positioned in the internal jugular vein or sigmoid sinus. Venography was performed before and after balloon inflation. Using standardized criteria, three neuroradiologists independently assessed visualization quality of venous structures, anatomical furthest extent of contrast enhancement, and pathology delineation. McNemar’s test was used for paired statistical comparisons between visualization with and without balloon occlusion. Results Balloon inflation improved rates of “well visualized” pathology from 15.7% to 88.2% ( p < 0.001, OR = 29.04). The most distant structure visualized shifted from the ipsilateral sigmoid sinus without balloon occlusion (visible in 45.1% of cases) to the contralateral sigmoid sinus with balloon occlusion (visible in 72.5% of cases, p < 0.001). With balloon occlusion, homogenous opacification and clear margin delineation of both transverse and sigmoid sinuses showed significant improvements ( p < 0.001 for both). No procedure-related complications were observed in this limited cohort. Conclusion In this feasibility experience, balloon-assisted occlusion during RCV improved visualization of the posterior and lateral dural venous sinuses and associated pathology. Future well-powered studies are needed to validate our findings and determine the definitive safety of this technique.

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