血管内介入治疗特发性颅内压增高并颅内静脉窦狭窄的现状及进展

Intravascular Interventional Therapy for Idiopathic Intracranial Hypertension Complicated with Intracranial Venous Sinus Stenosis: Current Status and Prospects

特发性颅内压增高(Idiopathic Intracranial Hypertension, IIH),也称为假性脑瘤(Pseudotumor Cerebri, PTC),是一种病因不明的非占位性的颅内压增高性疾病。其特征为颅内压升高的症状与体征,出现头痛(严重致残并降低生活质量)、恶心与呕吐,偶有复视(由于外展神经麻痹所致),常伴有心率减慢,视神经乳头水肿(具有永久性视力丧失的潜在风险)。而颅内静脉窦狭窄(Intracranial Venous Sinus Stenosis, IVSS)是一种少见的脑血管病,其横窦和乙状窦交界处的硬脑膜静脉窦狭窄导致局部静脉高压和通过蛛网膜颗粒的脑脊液引流的二次减少,越来越被认为是IIH病理生理学的重要组成部分,且部分静脉窦狭窄患者通过支架植入后IIH得以改善,这使得血管内介入治疗成为一种可选的治疗方法,但颅内静脉窦与IIH之间的因果关系仍未明确。作者旨在讨论IIH与静脉窦狭窄两者间的关系,及通过相关检查进一步说明两者直接的联系,并比较血管内介入治疗与其他外科手术的优缺点,以及血管内介入治疗在IIH治疗中的未来。

Idiopathic intracranial hypertension (IIH), also known as Pseudotumor Cerebri (PTC), is a non-space-occupying intracranial hypertension disorder of unknown etiology. It is characterized by signs and symptoms of elevated intracranial pressure, headache (severe disability and reduced quality of life), nausea and vomiting, occasional diplopia (due to abducens nerve palsy), often accompanied by slow heart rate, and papilloedema of the optic nerve (potentially at risk of permanent vision loss). And intracranial venous sinus stenosis (IVSS) is a rare cerebrovascular disease, in which dural sinus stenosis at the transverse sinus and sigmoid sinus junction results in local venous hypertension and secondary reduction of cerebrospinal fluid drainage through arachnoid particles. It has been increasingly recognized as an important part of IIH pathophysiology, and some patients with venous sinus stenosis have improved IIH after stent implantation, which makes intravascular intervention an optional treatment method, but the causal relationship between intracranial venous sinus and IIH remains unclear. This makes endovascular intervention an alternative treatment, but the causal relationship between intracranial venous sinus and IIH remains unclear. The purpose of this paper is to discuss the relationship between IIH and venous sinus stenosis, further explain the direct relationship between IIH diagnostic criteria and examination, and compare the advantages and disadvantages of intravascular intervention with other surgical procedures, as well as prospect the future of intravascular intervention in IIH treatment.