特发性颅内压增高症合并静脉窦狭窄的血管内治疗

Endovascular treatment for venous sinus stenosis in idiopathic intracranial hypertension

目的探讨特发性颅内压增高症（IIH）和颅内静脉窦狭窄的关系以及血管内治疗的疗效。方法回顾性分析2009年10月至2011年5月北京宣武医院神经外科和广东省人民医院神经内科收治的24例接受血管内治疗的合并侧窦狭窄的IIH患者，包括临床症状、眼底检查、颅内压、狭窄两端压力差、治疗的疗效及并发症等。治疗方法包括侧窦内支架植入术、球囊扩张术及机械性碎栓术。结果狭窄两侧压力差由术前（159±11）mmH2O（1mmH20=0．0098kPa），下降到术后的（85±11）mmH20。颅内压由术前的（314±56）mmH20，下降到（197±31）mmH20。术后16例患者头痛完全缓解或减轻，13例视力改善，10例视乳头水肿好转或消失，随访期有8例复查MRV／DSA，未见支架内再狭窄。结论对于合并静脉窦狭窄的IIH患者血管内治疗不失为一种有效的方法。

Objective To explore the relationship of venous sinus stenosis and idiopathic intracranial hypertension （IIH） and to discuss the efficacy and strategy of endovascular treatment. Methods Balloon angioplasty and stent placement were performed in 24 IIH cases by lateral sinus stenosis. Mechanical thrombus maceration was performed before stent placing in 5 cases with suspected chronic dural sinus thrombosis. The clinical data of clinical presentations, intraeranial pressure, pressure of lateral sinus, pressure gradient between distal and proximal lateral sinus stenosis, methods of treatment and therapeutic outcomes were retrospectively analyzed. Results Intracranial pressure dropped from （314±56） mm H20 of pre-operation to （197±31 ） mm H20 of post-operation. The post-treatment pressure gradient was obviously high（ （159±11 ） mm H20） and a reduction was found （（95±11 ） mm H20）. Headache in 16 cases, vision in 13 and papilledema in 10 were resolved or improved. There was no other permanent procedure- related morbidity. The patients were followed up for 2-19 months. And no in-stent restenosis occurred. Conclusion Endovascular treatment is effective for IIH by venous sinus stenosis.