Endovascular biopsy of an isolated sigmoid sinus intravenous lesion with newer-generation stent retriever: illustrative case.

backgroundIntravenous sinus meningiomas are rare tumors that may mimic idiopathic intracranial hypertension when they obstruct venous outflow. Biopsy of such lesions is challenging due to their deep location and the risks associated with open surgical approaches. OBSERVATIONS: A 40-year-old woman presented with worsening headaches, papilledema, and elevated intracranial pressure. Imaging revealed a homogeneously enhancing lesion within the right transverse-sigmoid sinus junction, causing venous occlusion. Despite medical therapy, symptoms persisted. An endovascular biopsy was performed using a NeVa NET stent retriever with aspiration. Three passes were made across the lesion, successfully yielding tissue for histopathological analysis. A diagnosis of benign meningioma was confirmed. The patient subsequently underwent ventriculoperitoneal shunt placement with significant clinical improvement. LESSONS: Endovascular biopsy using a stent retriever offers a safe, minimally invasive alternative to open surgical biopsy for intrasinus lesions. This technique is especially valuable in anatomically complex or high-risk locations where traditional approaches carry substantial morbidity. The use of newer-generation stent retrievers with integrated mesh structures may enhance tissue acquisition and diagnostic yield, guiding appropriate management in cases of isolated venous sinus lesions. https://thejns.org/doi/10.3171/CASE25456.