外伤性脑静脉窦血栓形成

Traumatic cerebral venous sinus thrombosis

目的 探讨外伤性颅内静脉窦血栓形成（CVST）的特点及治疗策略。方法 对11例外伤所致CVST的诊断、治疗进行回顾性分析。结果 11例CVST患者4例继发于颅骨未骨折的闭合性脑损伤，7例继发于颅骨线形骨折；以头部胀痛、视力下降、癫痫发作为其主要临床表现；头颅MRI及MRV和脑血管造影检查为该病提供确诊依据；11例患者中4例行抗凝治疗，7例行血管内治疗；治疗后6例患者痊愈，4例好转，1例无效，无严重并发症发生。本组中9例病人接受门诊和电话随访6个月至3年，疗效稳定，无一例复发。结论 颅脑损伤后不明原因颅内压增高，尤其是并发颅骨骨折时，应警惕CVST发生，尽早行神经影像学检查以明确诊断，血管内治疗协同抗凝治疗可提高其疗效。

Objective To investigate the clinical characteristics and therapeutic strategies of traumatic cerebral venous sinus thrombosis （CVST）. Methods The diagnosis and treatment were retrospectively analyzed in 11 cases of CVST. Results Among these CVST cases, 7 were found secondary to linear facture of skull and 4 were closed injury without skull fracture. Headache, visual disturbances and epileptic seizure were the main symptoms. The diagnosis depended on the combined examinations of CT, MRI, MRV and DSA. Of 11 cases, 4 had underwent anticoagnlation therapy and 7 had underwent endovascular therapy. The effective rate reached （10/11, complete cure in 6 and improvement in 4）, without severe complications. During the follow-up ranging 6 months to 3 years in 9 cases, the treatment effects were steady without obvious recurrence. Conclusion The patients with high intracranial pressures of unidentified causes, especially with skull fracture should accept neuroimaging examinations as early as possible to diagnose CVST anticoagnlation therapy have a favorable effect on CVST patients.