Symptomatic intracranial hypertension is a rare presentation of meningiomas associated with compression and/or invasion of the dural venous sinuses. Establishing a clear link between tumor-induced venous outflow obstruction and elevated intracranial pressure is essential to determine the appropriate management strategy.

A 59-year-old female presented with headaches, imbalance, pulsatile tinnitus, and horizontal binocular diplopia secondary to bilateral abducens nerve dysfunction in the setting of a small tentorial meningioma compressing the dominant right transverse sinus. Venous manometry demonstrated elevated sinus pressures and a large pressure gradient across the lesion. Microsurgical resection improved the caliber of the transverse sinus and normalized intracranial pressures without the need for permanent venous stent placement.

Tentorial meningiomas infrequently result in venous outflow obstruction and symptomatic intracranial hypertension. Thorough workup including diagnostic angiography, venous manometry, and temporary stenting can be used to confirm the diagnosis. Surgical resection with or without permanent stent placement can restore venous drainage and alleviate debilitating symptoms.

S.B.T., D.Y., and V.M.S. contributed to the conception of the study. S.B.T., R.R., R.J., and V.M.S. were involved in the literature review and drafting of the manuscript. All authors participated in the interpretation of data and reviewed and approved the final version of the manuscript.

Received: 16 May 2025

Accepted: 22 June 2025

Article published online:
22 July 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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