支架成形术治疗特发性颅高压综合征合并静脉窦狭窄的疗效

目的 探讨支架成形术治疗特发性颅高压(IIH)综合征合并静脉窦狭窄(CVSS)的疗效和安全性.方法 25例诊断难治型IIH合并局限性CVSS患者行静脉窦造影及压力测定,对其中狭窄两端压力差超过150mm H2O(1 mm H2O=0.0098 kPa)的14例患者行支架成形术治疗.术后检测静脉窦的形态、压力差、临床改善情况.随访6个月以上,观察并发症和静脉窦是否通畅.结果 所有患者支架成形术成功.术后未出现相关并发症,高颅压症状迅速缓解.随访期间临床症状无复发,DSA或磁共振静脉成像(MRV)检查显示静脉窦血流通畅,无再狭窄.结论 对于存在CVSS的IIH患者,血管内支架成形术治疗可能是一种相对安全、有效的治疗手段.

Efficacy of endovascular treatment for idiopathic intracranial hypertension: cerebral venous sinus stenosis treated by stenting

Objective To explore the diagnosis of cerebral venous sinus stenosis (CVSS) in idiopathic intraeranial hypertension(IIH),and to evaluate the efficacy and risk of venous sinus stenting treatment for CVSS.Methods Twenty-five patients with refractory IIH complicated with CVSS underwent examination with magnetic resonance venography(MRV),digital subtraction angiography(DSA)and direct retrograde cerebral venography and inanometry to confirm morphologic features of IIH and measure venous pressures.14 patients who showed severe stenosis of venous sinuses with the pressure gradient across the stenosis＞150 mm H2O(1mm H2O=0.0098 kPa)were treated with venous sinus stenting and were followed-up for more than 6 months.Intrasinus pressures and clinical progression were evaluated after the procedure.The IIH related clinical presentation,complications and the venous sinus condition were accessed during the follow-up period. Results Sinus stenting angioplasty was succeeded in all 14 patients.In all patients,venous sinus stenosis was improved after stenting procedure(the residual stenosis rate＜5%)and intrasinus pressure was reduced (the pressure gradient vanished or ＜20 mm H2O).The clinical symptoms in all the patients were impmved or disappeared at discharge and intracranial pressures were normalized within 3 monks after the procedure.During the follow-up period of (22.3±19.0) months (range 6 to 72 months),no patient had recurrence of IIH.In all cases,DSA or MRV was performed at 6-month follow-up and demonstrated absence of sinus thrombosis and stenosis.Conclusions Patients with IIH should be assessed for CVSS.MRV or DSA was recommended for these patients as a routine work-up.Cerebral venography and mauometry are helpful to evaluate the relation between venous ontflow obstruction and intracranial hypertension.If severe CVSS is presented in patient,endovascular treatment of venous sinus stenting shows promise as an alternative treatment. Additional randomized and controlled clinical research on treatment of CVSS is needed.