狭窄静脉窦支架扩张治疗假脑瘤综合征

Venous sinus stenting for pseudotumour cerebri with venous sinus stenosis

目的探讨静脉窦狭窄和假脑瘤综合征的关系以及支架扩张的疗效。方法回顾性分析应用支架扩张治疗的9例伴有静脉窦狭窄的假脑瘤综合征患者,包括临床症状、眼底检查、颅内压测定、脑血管造影情况、静脉窦各部位压力、治疗方法和疗效。结果支架置入前狭窄静脉窦两侧压力差明显,为(22.67±7.25)mmHg,支架置入后原狭窄静脉的两端压力差明显下降,为(5.78±3.77)mmHg,术后颅内压平均下降[(12.78±5.97)cm H2O]。所有患者颅内压增高症状在住院1周内均明显缓解,2周内完全消失;视力障碍7例在3个月内明显改善,2例无明显变化。无其他永久性介入相关并发症。临床随访3个月到5年,症状无复发。结论狭窄静脉窦支架扩张治疗对于部分伴有静脉窦狭窄的假脑瘤综合征患者是有效的治疗方法。

Objective To explore the relation between venous sinus stenosis and pseduotumour cerebri and to discuss the efficacy and strategy of venous sinus stenting for its treatment.Methods Venous sinus stenting was performed in a total of 9 patients with pseudotumour cerebri accompanied by dural sinus stenosis.The clinical data,including the clinical presentations,intracranial pressure,angiographic findings,pressure of dural sinus,methods of treatment and the therapeutic results,were retrospectively analyzed.Results Bilateral disc edema was seen in all patients.The pressure gradient in the lateral sinuses was obviously high before stenting（22.67±7.25）mmHg in all patients and a reduction in intra-sinus pressure and pressure gradient was also found（5.78±3.77）mmHg.The symptoms associated with intracranial hypertension were gradually improved or disappeared in two weeks after the placement of the stent in all cases,and the intracranial pressure dropped evidently（12.78±5.97）cm H2O.Vision was improved in 7 cases at three months,whereas it remained poor in 2 cases despite normalized intracranial pressure.There was no other permanent procedure-related morbidity.The patients were followed up for 3 months to 5 years,and no recurrence developed.Conclusion Lateral sinus stenting is an effective method for the treatment of pseudotumour cerebri with dural sinus stenosis.