重症颅内静脉窦血栓形成的血管内治疗

Endovascular Treatment for Serious Cranial Venous Sinus Thrombosis

目的探讨重症颅内静脉窦血栓形成血管内治疗方法的选择、溶栓药物的使用及其疗效和安全性。方法8例重症颅内静脉窦血栓形成患者均采用经静脉接触性溶栓治疗,其中2例联合机械性破栓术治疗,2例联合静脉窦内支架置入术治疗,2例动静脉联合溶栓治疗。结果除1例患者出现脑内血肿,留有一侧肢体轻瘫外,其余7例患者术中、术后均未出现与血管内治疗相关的并发症。出院时,患者格拉斯哥昏迷评分(GCS)评分由术前平均11分恢复到15分,原有的临床症状均得到改善(100%),闭塞的静脉窦均再通。平均随访12个月,所有患者腰穿压力均恢复正常,未出现血栓再形成和新的神经系统症状。结论对重症颅内静脉窦血栓形成患者采用合理的血管内介入治疗手段是有效的,对溶栓药物的使用、提高治疗安全性等问题上有待进一步研究。

Objective To explore how to select the ways of endovascular treatment for serious cranial venous sinus thrombosis,and how to use the thrombolytic,and to evaluate the curative effect and risk.Methods Eight patients with serious cranial venous sinus thrombosis,were all treated by transvenous thrombolysis,two combined with mechanical thrombus maceration,two combined with stenting,and two combined with intraarterial thrombolysis.Results Except one patient occurred intracerebral hemorrhage and remained hemiparesis.Others didn't have any complications related to endovascular treatment during and after the operation.At discharge,all patients Glasgow Coma Score(GCS)improved from average 11 of pre-operation to 15 of post-operation,and the nervous disorders improved,and venous sinuses were normal.In average 12 months follow-up,the pressure of lumbar puncture were normal in all patients.And there were no patient recurred or occurred new nervous symptom.Conclusion Reasonably using endovascular treatment actively in serious cranial venous sinus thrombosis is effective.And how to use the thrombolytic and how to improve the reliability are worth to need further investigations.