跨横窦硬膜外血肿并脑静脉窦血栓形成的诊治

Diagnosis and Treatment of Traumatic Cerebral Venous Sinus Thrombosis with Epidural Hematoma Spanning Transverse Sinus

目的探讨跨窦硬膜外血肿并脑静脉窦血栓形成的诊疗方法。方法对近三年来临床工作中发现的9例跨窦硬膜外血肿并脑静脉窦血栓形成患者的临床资料进行回顾性分析。所有病例诊断均经MRI、MRV证实,并静脉使用尿激酶溶栓治疗,首剂20万U,每日增加5万U。最大剂量40万U。结果9例跨窦硬膜外血肿并脑静脉窦血栓形成经治疗后4例再通,5例建立侧支循环;无1例死亡,无原有血肿扩大及再出血病例。结论对临床工作中发现腰穿颅内压大于300mmH2O,跨窦骨折合并硬膜外血肿的病例,应警惕静脉窦血栓形成。

Objective To study the pathogenesis, diagnosis and tretment of cerebral venous sinus thrombosis. Methods The clinical data of 9 patients with epidural hematoma spanning transmural sinuses and traumatic cerebral venous sinus thrombosis were treated in our hospital from November, 2002 to December, 2005 analysed retrospectively. The epidural hematoma and cerebral venous sinus thrombosis were definitely diagnosed respectively by MRI and magnetic resonance venograghy （MRV）. Urokinase was injected in travenously for thrombolysis with first dose of 0.2 million U and highest dose of 0.4 million U. The thrombolysis with urokinase lasted 1-3 weeks in all the patients. Results The cerebral venous sinuses occluded by the thrombosis were recanalized after the thrombolysis in 4 and the collateral circulations were established in 5 of 9 patients with cerebral sinus thrombosis. No patients died. There were not enlargement of the epiodural hematomas and re-hemorrhage in all the patients after thrombolysis. Conclusion Traumatic cerebral venous sinus thrombolysis shall be suspected if there are the cranial fracture and epidural hematoma spanning the transverse sinus, especially intracranial pressure of more than 300 mm H20 measured by lumbar puncture in the patients with brain injury.