脑静脉窦血栓形成影像诊断及血管内治疗进展

Progress in imaging diagnosis and endovascular treatment of cerebral venous sinus thrombosis

脑静脉窦血栓为脑血管疾病,是由于各种原因导致的脑静脉系统狭窄及闭塞,患者颅内静脉回流受阻,导致颅内压增高,其发生率占所有脑卒中的1%。由于脑静脉窦血栓发病早期临床症状缺乏典型性,且患者发病后并不会引起脑室扩张,亦不会引起脑积水,导致临床诊疗难度较大,亦影响患者治疗预后。数字减影血管造影(DSA)检查是脑静脉窦血栓患者临床诊断的“金标准”,检查可靠性高,但其存在一定风险,还具有创伤性,导致患者的耐受性较差。目前,临床上对于脑静脉窦血栓诊断以影像学方法为主,包括:计算机断层扫描(CT)、磁共振(MRI)、磁共振静脉成像(MRV)及DSA等,不同影像学检查方法各有优缺点,均能为患者诊疗提供参考依据。而对于脑静脉窦血栓治疗以抗凝治疗、病因治疗与血管内治疗为主,借助上述方法能防止血栓扩展,促进血栓溶解,能延缓病情发展,但是临床上患者选择何种治疗方法缺乏统一标准。因此,本综述将以脑静脉窦血栓为出发点,分析脑静脉窦血栓常用的影像学检查方法,探讨血管内治疗脑静脉窦血栓效果,为临床诊疗提供参考依据。

Cerebral venous sinus thrombosis is a cerebrovascular disease,which is caused by the stenosis and occlusion of cerebral venous system due to various reasons.The intracranial venous return of patients is blocked,resulting in increased intracranial pressure,and its incidence rate accounts for 1%of all stroke.Due to the lack of typicality in the early clinical symptoms of cerebral venous sinus thrombosis and the absence of ventricular dilation or hydrocephalus after the onset of the disease,the clinical diagnosis and treatment are difficult,and the treatment prognosis of patients is also affected.DSA examination is the"gold standard"for clinical diagnosis of cerebral venous sinus thrombosis.It has high reliability,but it has certain risks and is traumatic,which leads to poor tolerance of patients.At present,imaging methods are mainly used in clinical diagnosis of cerebral venous sinus thrombosis,including CT,magnetic resonance(MRI),magnetic resonance venous imaging(MRV)and DSA,etc.Different imaging methods have their own advantages and disadvantages,but all can provide reference for the diagnosis and treatment of patients.The treatment of cerebral venous sinus thrombosis mainly includes anticoagulant treatment,etiological treatment and endovascular treatment.The above methods can prevent thrombosis expansion,promote thrombolysis and delay the development of the disease.However,there is no unified standard for patients to choose the treatment methods clinically.Therefore,this review will take cerebral venous sinus thrombosis as the starting point,to analyze the commonly used imaging examination methods of cerebral venous sinus thrombosis,explore the effect of endovascular treatment of cerebral venous sinus thrombosis,and provide reference for its clinical diagnosis and treatment.