出血性脑静脉窦血栓的血管内治疗

Intravascular therapy for hemorrhagic thrombosis in cerebral vein and sinuses

目的探讨合并颅内出血的脑静脉和静脉窦血栓治疗方法。方法对17例患弥漫性脑静脉和静脉窦血栓合并蛛网膜下腔和脑实质内出血者,采用经颈动脉和椎动脉内间断溶栓和静脉窦内留置微导管连续溶栓5-10d;同时辅以全身抗凝治疗2年。结果治疗后经脑CT复查证实,15 例颅内出血在1周内得以控制,1个月内蛛网膜下腔出血和脑内血肿均完全吸收。颅内压在治疗2 周后,基本稳定在280mm H2O以下。2例颅内出血严重,于治疗3d后死亡。结论同时应用血管内溶栓和全身抗凝是治疗合并蛛网膜下腔和脑内出血的脑静脉和静脉窦血栓的较为可靠和安全的方法之一。

Objective To evaluate the therapy of thranbosis of cerebral veins and sinuses with intracranial bleeding. Method In 17 cases with diffused thrombosis of cerebral veins and sinuses with hemorrhage in subarachnoid space and cerebral parenchyma, the intermittent thrombolysis via carotid or vertebral artery and sequence thrombolysis with selective catheterizing via jugular approach for 5～10 days were used. At the same time, the general anticoagulation had lasted for 2 years. Results The re-examination of CT scanning after treatment demonstrated that introcranial bleeding was controlled in one week and the cerebral haematoma as well as subarachnoid haemorrhage were completely absorbed among 15 cases in one month. The ICP was lower than 280mm H2O after thrombolysis and anticoagulation in 2 weeks. Only 2 cases with severe intracranial haemorrhage died in 3 days. Conclusion The therapy with both endovascular thrombolysis of the methods safer and more reliable for thrombosis in cerebral bleeding. and general anticoagulation was one veins and sinuses with intracranial