血管内支架成形术治疗脑静脉窦狭窄(附36例报告)

Endovascular stent-support angioplasty for cerebral venous sinus stenosis

目的探讨脑静脉窦狭窄的病理生理机制及支架成形术治疗的方法和效果。方法回顾性分析2001年12月-2010年6月解放军总医院神经外科收治的36例脑静脉窦狭窄患者,其中男10例,女26例,年龄14~57岁,平均37.8岁,病程4d^9年,主要临床症状为头痛、呕吐、视物模糊,部分患者有肢体无力并麻木等。所有患者均经血管造影确诊,其中21例局限性狭窄位于右侧横窦乙状窦移行部,12例位于左侧横窦乙状窦移行部,3例双侧均有局限性狭窄。采用经颈动脉注射溶栓或静脉窦内置管溶栓,然后行静脉窦支架置入治疗,同时辅以全身抗凝及抗血小板治疗。结果 36例患者行静脉窦球囊扩张并支架成形术,除3例因支架难以通过迂曲的颈静脉孔而失败外,余均获成功,技术成功率91.7%。术后腰穿测定脑脊液压力由术前的374.7±82.9mmH2O降至术后的230.3±48.1mmH2O。33例患者通过全脑血管造影、门诊随访1个月~8年,其中32例临床表现持续缓解,1例患者支架置入后1个月头痛加重,视力模糊,经颈动脉溶栓及足量抗凝处理后症状明显缓解。结论静脉窦支架成形术治疗静脉窦狭窄导致的颅内压升高安全有效,但长期疗效有待进一步观察。

Objective To investigate the pathophysiological features of cerebral venous sinus stenosis,and the modus and therapeutic effect of stent-support angioplasty.Methods The clinical data of 36 patients with cerebral venous sinus stenosis,admitted to Neurosurgical Department of General Hospital of PLA from Dec.2001 to Jun.2010,were retrospectively analyzed.Of the 36 cases,10 were males and 26 females,aged from 14 to 57 years with a mean of 37.8 years,and the disease course ranged from 4 days to 9 years.The main clinical manifestations included headache,vomiting,optical visual blurring,and limb weakness with anesthesia in some patients.The diagnosis of all patients was confirmed by digital subtraction angiography,and the results showed that the local stenosis located in right transverse-sigmoid sinus in 21 cases,left transverse-sigmoid sinus in 12 cases,and on both sides in 3 cases.All patients received thrombolytic therapy via carotid artery or a microcatheter inserted in the venous sinus,followed by stent angioplasty of venous sinus.Meanwhile,general anticoagulant and antiplatelet therapy were essential.Results All the 36 patients were successively treated with balloon dilatation and stent angioplasty of venous sinus with exception of 3 cases,who failed because of the circuitous jugular foramen preventing the insertion of the stent.The successful rate was 91.7%.The cerebrospinal fluid pressure of the patients was lowered from 374.7±82.9mmH2O before operation to 230.3±48.1mmH2O after operation.Thirty-three patients were followed-up for 1 month to 8 years by brain angiography and examinations in the outpatient clinic.Among them 32 showed persistent relief of clinical symptoms.The remaining patient presented severe headache and optical visual blurring 1 month after stent implantation,however the symptoms were alleviated obviously after thrombolytic therapy via the carotid artery with adequate anticoagulation.Conclusions Stent angioplasty of venous sinus is an effective and safe therapeutic method for high intracranial pressure induced by sinus stenosis.However,further studies are warranted to demonstrate its long-term efficacy.