多发性脑静脉和静脉窦血栓的诊断和溶栓治疗

Diagnosis and endovascular treatment of multiple cerebral venous and venous sinuses thrombosis

目的 本文报告 85例多发性脑静脉和静脉窦血栓的诊断和血管内溶栓治疗。方法 依MR影像在相应脑静脉窦区出现长T2 ,短T1信号和DSA显示脑静脉窦充盈缺损 ,及脑小静脉扩张迂曲和静脉期循环时间延长是血栓形成的根据。治疗中以间断穿刺颈动脉和静脉窦内留置微导管注入尿激酶为主 ,并辅以口服华法林抗凝。结果 1周后复查脑血管造影 ,5 / 18例静脉窦出现部分再通 ;8/ 18例脑循环时间接近正常 ,12例小静脉迂曲扩张现象明显改善。治疗 10d后 ,80例颅内压降至 2 30～30 0mmH2 O ;临床病情显著缓解 ,与脑血管造影基本符合。结论 本组资料表明 。

Objective Eightyfive cases with multiple cerebral venous and venous sinuses thrombosis including the diagnosis and endovascular therapy were reported.Methods The long T2 and short T1 signals in the related rigions of multiple venous sinuses on MRI and prolonged blood circulation time of the brain with tortuous dilatation of vein in angiography were the important characteristics for the diagnosis. Of the 85 cases, the treatment procedures were consisted of injecting urokinase intermittently via common carotid artery and intrasinus contact thrombolysis as well as warfarin intake orally. Results Intracranial pressure of 80 cases reduced down between 230 and 300 mmH 2O, and clinical deficits were markebly improved within 10 days. Reangiography of 18 cases revealed recanalization partly in 5 cases and circulation time appeared near normal in 8 cases during one week after therapy. Conclusions Combined intraarterial thrombolysis consecutively with general anticoagulation for the treatment of multiple thrombosis in cerebral venous sinuses may be one of the effective means.