上矢状窦血栓形成诊断和治疗进展

上矢状窦血栓形成(superior sagittal sinus thrombosis,SSST)是一种特殊类型的脑血管疾病,多因误诊漏诊而引起严重并发症甚至死亡。随着神经影像学和神经介入学发展以及新型抗栓药物的应用,其早期发现率和诊断率大大提高,预后明显改善,现对其诊断和治疗进展作一综述。一、病因     

上矢状窦血栓形成22例临床报告

上矢状窦血栓多见于产后,由于计划生育的普遍开展,城乡卫生条件不断改善,所以该病的发病率明显降低。近几年来,我科收治上矢状窦血栓22例,为提高该病的认识,本文将重点讨论上矢状窦静脉血的来源、颅内静脉特点和临床与病理之间的关系。资料 1.一股资料:21～30岁21例,32岁1例。     

上矢状寞、直窦血栓形成一例报告

本文报告经MRI证实的产后上矢状窦直窦血栓形成1例。     

上矢状窦血栓形成1例报告

上矢状窦血栓形成临床诊断较难 ,易于误诊 ,现报告 1例如下。1　病例　女 ,2 1岁。因分娩后频繁四肢抽搐 4天 ,伴神志不清 3天而于 1999年 4月 2 2日入院。患者于入院前 4天初次足月顺产一健康女婴。分娩后 4小时下床解小便时突然意识丧失、全身肌肉强直 ,继而四肢抽搐、两眼上翻、牙关紧闭、口吐白沫、嘴唇青紫 ,持续 5分钟自行缓解 ,但诉头痛 ,不久又昏睡伴有躁动、惊叫。每 2～ 3小时四肢抽搐发作 1次。次日抽搐更加频繁 ,约每小时 1次 ,且神志由嗜睡、谵妄逐渐转入昏迷。起病以来有不规则发热 ,无呕吐。无癫痫病史 ,产前未患过妊高征。…     

分娩后上矢状窦血栓误诊1例

患者女性，23岁，既往体健，平素性格温和。无阳性家族史。病前无严重躯体疾病史。顺利分娩一男婴，7d后回家。3d后孩子突然天折，闻讯后出现不语、发呆、失眠、不认人，吃饭不知往嘴里放。上述症状呈阵发性，缓解时知道安慰爱人和婆婆不要着急上火。体检四肢肌张力稍减弱，眼底检查不合作。精神检查：抬入病室，呈嗜睡状态，接触被动，缄默     

硅胶管重建上矢状窦的实验性研究

目的探讨硅胶管作为上矢状窦重建的替代材料的可行性及其近期效果。方法对７只犬进行硅胶管上矢状窦重建术，术式分窦腔置管法（５只），端－端吻合法（２只），术前及术后１、２、４、８周行造影及组织学检查，观察重建效果及组织学变化。结果５只犬通畅良好（置管法４只，端－端吻合法１只），２只失败（置管法、端－端吻合法各１只）。结论硅胶管作为上矢窦重建的替代材料近期效果是良好的     

上矢状窦旁脑膜瘤致上矢状窦阻塞时侧支静脉通路的意义

目的 分析上矢状窦旁脑膜瘤致上矢状窦(SSS)阻塞时其侧支静脉通路的建立情况，确定其在肿瘤切除术中的意义。方法 总结归纳86例上矢状窦旁脑膜瘤行MRA及DSA检查时的静脉系表现。结果 27例发生SSS完全阻塞，59例部分阻塞。18例在阻塞的SSS周围出现了由表浅皮层静脉所形成的侧支静脉环；通过表浅皮层静脉与蝶顶窦及小脑幕静脉系建立端—端吻合的16例；通过与Troland或Labbe静脉建立吻合的14例；通过大脑镰与下矢状窦吻合的9例；通过脑膜静脉并经板障静脉引流到颈外静脉系的17例；混合型12例。结论 上矢状窦旁脑膜瘤致SSS阻塞时，肿瘤周围存在广泛侧支静脉通路，术中应注意保护。脑DSA及MRA检查对术前了解SSS通畅性及侧支静脉通路建立有帮助。     

产褥期合并上矢状窦血栓形成的护理

目的 探讨产褥期合并上矢状窦血栓形成的护理。方法 通过对5例患者采取密切观察病情,适当控制摄水量,做好症状护理,消除引起颅内压骤然升高的诱因,加强基础护理和功能锻炼,防止并发症发生等措施。结果 4例患者治愈,1例死亡。结论 对患者采取各项预见性的护理措施,防止颅内压骤然增高,对抢救患者的生命和促进康复极为重要。     

外伤性上矢状窦损伤的临床诊治

目的探讨外伤性上矢状窦损伤的临床诊断与手术方法,提高患者的生存率及生存质量。方法回顾性分析18例外伤性上矢状窦损伤的诊治经过。18例中,行上矢状窦修补15例,硅胶管临时搭桥辅助下静脉窦吻合术3例。结果术后3个月随访,按GOS评估预后:良好11例,中残3例,重残2例,植物生存1例,1例死于严重脑肿胀。结论外伤性上矢状窦损伤手术前应根据颅骨骨折类型、部位及程度对静脉窦损伤作出诊断,充分准备,快速控制大出血,果断采取不同的止血及修补措施,以达到止血及恢复静脉窦通畅的目的。     

上矢状窦血栓的病因及诊断

目的 探讨上矢状窦血栓的病因及诊断方法。方法 分析34例上矢状窦血栓患者的病因、临床表现、影像学特征，其中3例无明确诱因所致上矢状窦血栓患者，利用化学分光法检测其血清中的雌二醇（E2）、睾酮（T）水平。结果 上矢状窦血栓最常见的病因是产褥期血液高凝状态。3例未查到明确诱因的青年男性患者，血清中E2↑、E2／T↑。上矢状窦血栓的临床表现以头痛最常见，在意识清楚的30例患者中发生率为100％。影像学检查：CT检出率仅为65．4％，磁共振成像（MRI）、磁共振静脉血管造影（MRV）检出率为100％。结论 各种原因造成的血液凝固性增高是上矢状窦血栓最常见的病因，男性高雌激素血症是其发病的一个重要的危险因素。MRI和MRV技术相结合是诊断上矢状窦血栓的最佳方法。     

骑跨上矢状窦硬膜外血肿的临床特点与治疗体会(附13例报告)

骑跨上矢状窦硬膜外血肿在临床上可归为一组特殊类型硬膜外血肿．其出血来源、病情发展、手术方式均与其它种类不同，术中出血凶猛、死亡率高。特别是顶部骑跨矢状窦硬膜外血肿，在血肿较小时，常规轴位扫描可见不到血肿，即使有血肿显示．也很难窥其全貌．不出现常见的双凸形高密度影，易发生漏诊或误诊。2001年-2006年我科收治13例骑跨上矢状窦硬膜外血肿病例。本文结合文献，对其临床特点、产生机制、手术方式及注意事项进行分析探讨。     

上矢状窦血栓形成早期大脑灰质CT特殊表现(附1例报道及文献复习)

目的分析上矢状窦血栓形成的早期大脑灰质CT特点,提高对上矢状窦血栓形成早期大脑灰质CT特点的认识。方法结合文献对1例上矢状窦血栓形成患者的早期脑CT影像学特点进行分析。结果患者发病后6h行脑CT平扫显示双侧额叶皮质高密度影;第3d时脑MRIT1显示上矢状窦前部血栓形成可疑,脑FLAIR-MRI显示右侧额叶高信号及左侧额叶弧形高信号,脑MRIT1相增强扫描显示双侧额叶皮层弧线型增强,MRV显示上矢状窦前1/3处见一无信号区,周围有侧枝循环形成;治疗第6d时复查脑CT和MRI均无出血征象。结论患者早期脑CT所显示的高密度影可能是皮层静脉和毛细血管血液淤积的显示,并不全是出血,对于该征象的认识并结合病理生理过程给予的合理解释对于及时正确的认识该病具有重要意义。     

Direct drainage of extracranial arteries into the superior sagittal sinus associated with dementia

Summary A 62-year-old man suffered from progressive dementia for the last 5 years of life. Angiography disclosed draining of multiple extracranial, galeal arteries directly into the superior sagittal sinus with retrograde filling of cerebral veins. At necropsy there was arterialization of the walls of the sinus and a multichannelled lumen in its middle third. The sinus was not distended, the dura normal, and no angioma was found. The leptomeninges and the cerebral white matter contained excessively distended veins, some with thickend fibrotic walls. Many arteries in the cerebral white matter were mineralized. There were widespread patches of incomplete demyelination about these abnormal vessels. The lesion was classified as a developmental anomaly with direct shunting of extracranial arteries into the superior sagittal sinus.

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Zusammenfassung Fallbericht eines 62jährigen Mannes, der während der letzten 5 Jahre an einer progredienten Dementia litt. Angiographische Untersuchungen zeigten multiple Shunts extracranieller Galeaarterien direkt in den Sinus sagittalis superior mit retrograder Füllung der Venen der Großhirnhemisphären. Bei der Autopsie fand sich Arterialisation der Wand des Sinus sagittalis superior mit multiplen Lumina in seinem mittleren Drittel. Der Sinus war nicht dilatiert, die Dura normal, und kein eigentliches Angiom wurde gefunden. Dilatierte Venen in den Leptomeningen und in der hemisphärischen weißen Substanz zeigten gelegentlich verdickte fibrotische Wandungen. Arterien der weißen Substanz waren vielfach verkalkt. Derartige abnormale Gefäße waren von ausgedehnten Herden unvollständiger Entmarkung umgeben. Die Läsion wurde als eine Entwicklungsstörung klassifiziert, charakterisiert durch multiple direkte Shunts in den Sinus sagittalis superior.

     

The permeability to exogenous protein of the wall of the superior sagittal sinus of the cat

The permeability of the wall of the superior sagittal sinus of the cat has been studied using horseradish peroxidase (HRP) as an exogenously applied tracer. Cats were given intracisternal or intravascular injections of HRP before being perfused transcardially for examination of sinus tissues with the electron microscope. Tissues were processed with diaminobenzidine to reveal peroxidase activity. A diffusion barrier to the protein tracer was seen to occur at the level of the arachnoid mater. When injections of HRP were made into the cisterna magna, the protein was able to course through the subarachnoid space surrounding the sinus, and sequestration of the tracer was seen in deep cell layers of the arachnoid mater. However, a series of zonulae occludentes at more apical levels of the arachnoid prevented the tracer from penetrating intercellularly to the level of the dura mater. Conversely, when HRP was given intravascularly, the protein penetrated intercellular spaces of the dura mater and apical levels of the arachnoid mater, stopping at the level of the zonulae occludentes of the arachnoid. This barrier layer appears to be continuous with the arachnoid barrier layer which prevents diffusion of large molecules through the arachnoid mater over the brain convexities.     

Surgical treatment of parasagittal and falcine meningiomas invading the superior sagittal sinus

ObjectiveWe present our experience with surgery of parasagittal and falcine meningiomas invading the superior sagittal sinus with special consideration of the surgical complications and the incidence of tumour recurrence.Materials and methodsThe analysis included 37 patients with parasagittal and falcine meningiomas invading the superior sagittal sinus. In 13 cases, the sinus was ligated and resected with tumour. In 14 cases, the sinus was entered with the goal of tumour resection and the sinus was reconstructed, while in 10 patients the sinus was not entered and the remaining residual tumour was observed for growth.ResultsOut of 13 patients after radical resection of the tumour and invaded part of sinus, 9 revealed haemodynamic complications: venous infarction (4), significant brain oedema (3) and hypoperfusion syndrome (2). 2 out of 14 patients after resection of the tumour from the lumen of the superior sagittal sinus with subsequent sinus repair developed venous infarction after surgery. Among 27 patients after radical tumour excision the remote follow-up revealed recurrence in 2 patients. There were no significant haemodynamic complications in none of 10 cases, in which the residual tumour was left after surgery in the superior sagittal sinus. In this group, 3 cases were subjected to early post-operative radiotherapy and local recurrence was observed in 4 patients.ConclusionsThe aggressive surgical treatment of meningiomas infiltrating the superior sagittal sinus is associated with a high surgical risk. The incidence of recurrence of these tumours increases significantly in the case of non-radical excision of the tumour.