重症硬脑膜静脉窦血栓的局部溶栓治疗

目的 研究重症硬脑膜静脉窦血栓的局部溶栓治疗的方法及疗效。方法 总结我院自2000年以来6例重症硬脑膜静脉窦血栓的局部溶栓治疗经验，男4例，女2例，其中4例采用一侧股动脉及对侧股静脉Seldinger穿刺，2例采用股动脉Seldinger穿刺及上矢状窦前1／3穿刺。导管置入一侧颈内动脉及静脉窦血栓处后，于颈内动脉及静脉窦血栓处先后各用尿激酶50万U，以每分钟1万U泵入，再于静脉窦血栓处泵入尿激酶持续溶栓，维持外周血中纤维蛋白原含量1．0～1．5g／L，同时予全身肝素化，维持外周血活化部分凝血活酶时间正常值的2～3倍。结果 本组6例，5例痊愈，颅内压转正常，头痛消失，无神经功能障碍，其中4例数字减影血管造影(DSA)见浅表静脉扩张消失，静脉窦显影正常，1例浅表静脉扩张明显改善，静脉窦显影较前好转；1例好转，颅内压较前降低，头痛好转，DSA见浅表静脉扩张消失，静脉窦显影正常，抗凝治疗1个月后颅内压正常，头痛消失，神经功能恢复正常。结论 重症硬脑膜静脉窦血栓采用动静脉系统联合应用尿激酶局部溶栓治疗是快速、安全、有效的方法，经股静脉途径不易到达静脉窦血栓处者，可以行上矢状窦入路。     

Multiple dural arteriovenous fistulas of the cranium and spine

Dural arteriovenous fistulas are acquired lesions that usually involve the dura around the cavernous sinus. The transverse, sigmoid, and superior sagittal sinuses may be affected occasionally. With the exception of bilateral cavernous sinus dural arteriovenous fistulas, the simultaneous occurrence of dural arteriovenous fistulas at two locations is rare. Among 105 patients evaluated for dural arteriovenous fistulas, we identified seven patients with fistulas at two sites. The age of the patients ranged from 27 to 74 years. Presentation was related to hemorrhage in three patients, loss of vision in four, and a bruit and headaches in one. Patients were treated with combined surgical and endovascular techniques. All treated lesions were completely closed with no mortality or permanent morbidity. The presence of multiple fistulas must be considered in patients being evaluated for dural arteriovenous fistulas. Patients with multiple fistulas usually present with life-threatening hemorrhages or acute neurologic decline; the risk factor for hemorrhages, including those related to venous outflow obstruction, is high in patients with multiple dural arteriovenous fistulas.     

New experimental model of sinus and cortical vein thrombosis in pigs for MR imaging studies

Introduction Diagnosis of cerebral sinus vein thrombosis is still a challenge for imaging. MRI and MRA play a major role in sinus imaging. For further development of MR techniques, MR-compatible animal models are required. The aim of this study was to develop an animal model for sinus thrombosis and additional cortical vein thrombosis with a clot of human blood for MR imaging studies.Methods A combined surgical and interventional approach was carried out in 13 pigs. After minimal invasive surgical access to the anterior superior sagittal sinus and cortical vein, thrombosis with human blood was induced using an interventional catheter approach. MR imaging was performed prior to and after thrombus induction.Results Sinus thrombosis was induced in 12 of 13 animals. Three animals suffered acute subdural haemorrhage; one of these animals died during the intervention, and one died after thrombus induction. MR imaging of the thrombosed sinus could easily be performed without significant artefacts in 11 of 13 animals.Conclusion This new model of sinus and cortical vein thrombosis with a clot of human blood allows artefact-free imaging studies on MR.     

Anomalous intracranial drainage of the nasal mucosa: a vein of the foramen caecum?

The existence of the vein of the foramen caecum (VFC) in humans is still controversial. We present 2 patients with intracranial drainage of the nasal mucosa by a frontal cortical vein into a superior sagittal sinus, demonstrated by digital subtraction angiography. In both, the position of the intracranial passage was found to be slightly paramedian. An analogy to the VFC is made.     

旁路移植生物材料重建上矢状窦动物模型研究

目的建立比格犬上矢状窦旁路移植模型,探索利用此模型移植生物型材料重建上矢状窦的可行性。方法健康成年雄性比格犬8只,体重12.5～22.0kg,骨窗开颅暴露两侧上矢状窦并阻断后,在显微镜下行移植材料与上矢状窦的端-侧吻合,术后给予抗感染等对症处理。分别于移植后1、24、8、周进行上矢状窦造影和彩色多普勒检查(CDFI),8周时处死动物,行植入材料的组织学检查。结果术后上矢状窦造影和CDFI检查显示,8只犬中2只吻合口轻度狭窄、CDFI流速较高,1只吻合口有少许渗漏、CD-FI流速稍低,另5只上矢状窦造影及CDFI检查均无异常。8周后植入材料和上矢状窦吻合处均有内皮细胞生长,并向移植材料内爬行。结论成功建立了上矢状窦旁路移植模型,近期效果良好,但远期效果尚有待进一步观察。     

上矢状窦撕裂的CT诊断(附9例分析)

目的：分析上矢状窦撕裂的CT表现,讨论本病的CT诊断及其价值。方法：回顾分析经手术证实的9例上矢状窦撕裂的CT片,探讨其CT表现特点,评价其临床价值。结果：9例上矢状窦撕裂,其中5例撕裂位于前段,4例位于中段,血肿集中于撕裂部位,中段撕裂血肿明显较大;CT诊断正确7例。主要CT表现：9例CT扫描均见上矢状窦变形增大,其中4例表现为“带征”,3例“三角征”,2例不规则形;7例硬膜外并硬膜下血肿,血肿位于大脑镰旁,大血肿内见小血肿影。呈血肿“叠加”表现;7例中线部颅盖骨骨折;7例侧脑室下移;5例中线结构居中,4例略偏移。结论：上矢状窦撕裂的CT表现具有一定的特征,CT扫描有助于定位及定性诊断,为临床制订手术方案和确定手术入路提供依据。     

Gradient recalled echo MR imaging of superior sagittal sinus occlusion

Summary With T1-weighted gradient recalled echo (GRE) MR images and flow compensation, we studied the superior sagittal sinus in 3 normal volunteers and 3 patients with sinus occlusion. In these images, sites of patency of the superior sagittal sinus were identified due to the high signal intensity of the normal sinus. Tumor invading the sinus was nearly isointense with cerebral gray matter. T1-weighted GRE imaging proves to be an effective technique to evaluate sinus blood flow.     

Treatment of dural arteriovenous malformations involving the superior sagittal sinus

We report the diagnosis and treatment of seven dural arteriovenous malformations involving the superior sagittal sinus. The most common presenting symptom was headache, although two patients presented with hemorrhage. Embolization alone effected a complete cure in four patients, while a combination of embolization and surgery was used in the remaining three patients. The first of these had intraoperative exposure and embolization of multiple feeding branches of both middle meningeal arteries, which resulted in a complete cure without deficits. The second patient had multiple embolizations and surgeries with eventual resection of the involved sagittal sinus to effect a complete cure, which was complicated postoperatively by paraparesis. The third patient had preoperative embolization and subsequent surgical resection of the superior sagittal sinus, resulting in a complete cure without deficits. Because of their unique midline location, multiplicity of arterial feeders, and critical venous drainage, dural malformations involving the superior sagittal sinus often require unusual and aggressive forms of therapy.     

A case of intravascular lymphomatosis with sinus thrombosis]

We report a rare case of intravascular lymphomatosis with massive tumor in the superior sagittal sinus (SSS), which caused sinus thrombosis. A 63-year-old man was incidentally found to have an enhancing mass in the superior sagittal sinus on MRI. The tumor manifested spontaneous regression during with 4 month's follow-up. Five months after the initial MR examination, T2-weighted MR images revealed a area of hyperintensity in the right occipital lobe. The area showed hypointensity on diffusion-weighted image and showed hyperintensity on ADC mapping, findings that are compatible with vasogenic edema.     

Postpartum superior sagittal,left transverse sinus and right internal jugular vein thrombosis with left parietal infarct: A case report

Cerebral venous sinus thrombosis is a rarely occurring condition. Pregnancy and postpartum are both known risk factors for cerebral venous sinus thrombosis. Early detection and treatment are critical, as CVST can be potentially life-threatening. Here, we present a case of a patient who developed left transverse and superior sagittal sinus thrombosis 15 days after normal vaginal delivery. The patient presented to the emergency department with complaints of irritability and an altered state of consciousness for two days. The patient also developed seizures extending from the lower limb to the upper body. Laboratory investigations revealed abnormalities in the complete blood count report and urine complete examination. The patient''s coagulation profile was totally abnormal, indicating a presence of a thrombus. All the other diagnostic techniques, including Electrocardiogram, Carotid Doppler Scan, and Ultrasound abdomen, revealed no findings. However, Magnetic resonance venography + Magnetic resonance imaging showed partial superior sagittal sinus thrombosis in the anterior and upper parietal regions, right internal jugular vein thrombosis, and left transverse thrombosis with associated left parietal infarcts. The presence of thrombosis in sinuses and jugular vein resulted in seizures, altered state of consciousness, and other associated symptoms. The patient was treated with sodium valproate, heparin, and other medications accordingly. The above-mentioned case was unique due to the involvement of unusual sinuses (transverse sinus) as previous studies have only reported cases of thrombus presence in the superior sagittal sinus. This case study will discuss patient diagnosis and management with Heparin and Diazepam to stop altered state of consciousness and seizures in females.     

Superior sagittal sinus thrombosis: assessment with Tc-99m labeled red blood cells

The diagnostic value of scintigraphy with technetium-99m labeled red blood cells (Tc-RBC) was assessed in 19 patients with clinical suggestion of superior sagittal sinus thrombosis (SSST). Comparison of Tc-RBC static images with dynamic flow studies in the brain showed a sensitivity of 100%, specificity of 86%, and accuracy of 94% for static studies and values of 87%, 20%, and 61%, respectively, for the flow studies. Tc-RBC scintigraphy enables direct visualization of the integrity of the superior sagittal sinus, whereas CT scanning shows various but nonspecific changes in the brain associated with SSST. Single-photon emission CT study using Tc-RBC, performed in six patients, appears to have potential in the diagnosis of SSST, allowing separation of vascular structures that are superimposed on the superior sagittal sinus in planar scintigraphy study.     

窦镰旁脑膜瘤肿块与窦镰关系的MRI研究

目的　探讨窦镰旁脑膜瘤肿块与窦镰关系的MRI表现特征。资料与方法　搜集经手术和病理证实的 33例窦镰旁脑膜瘤的MRI资料。 2 3例使用ElscintGyrexV 0 .5TMR扫描仪检查 ,1 0例使用ToshibaVisart/EX 1 .5TMR扫描仪检查 ,常规SE序列平扫和增强扫描。结果　 33例窦镰旁脑膜瘤除具有一般脑膜瘤的MRI表现外 ,其肿块与窦和 /或大脑镰的关系所具有的MRI特征为 :(1 )肿块跨越征 ;(2 )矢状窦受压、填塞征 ;(3)肿块内侧缘平直征 ;(4)大脑镰向肿块侧扭曲征 ;(5)大脑镰局限增厚征等。结论　MRI是揭示窦镰旁脑膜瘤肿块与窦镰关系的优良方法 ,且对手术治疗具有重要价值     

Physiologic variations in dural venous sinus flow on phase-contrast MR imaging

OBJECTIVE: Our study quantifies normal physiologic variations of dural sinus flow using phase-contrast MR imaging. SUBJECTS AND METHODS: Fifteen volunteers were imaged using nontriggered and triggered phase-contrast MR venography of the superior sagittal and transverse sinuses. Triggered scans were obtained during regular breathing; nontriggered scans were obtained during regular breathing, breath-holding, deep inspiratory breath-holding, and deep expiratory breath-holding. Analysis of variance, Bonferroni method, and Dunn post hoc analysis were used to determine any significant differences in the mean flow and velocity between the different breathing maneuvers. A paired t test was used to compare flow between sinuses during regular breathing. RESULTS: Deep inspiratory breath-holding and deep expiratory breath-holding resulted in a significant decrease in blood flow and velocity in all dural sinuses compared with regular breathing. During deep inspiratory breath-holding, blood flow decreased 30.8% in the superior sagittal sinus, 19.7% in the left transverse sinus, and 19.1% in the right transverse sinus. Similarly, during deep expiratory breath-holding, blood flow decreased 30.2% in the superior sagittal sinus, 20.8% in the left transverse sinus, and 20.3% in the right transverse sinus. The sum of the flow in the transverse sinuses was significantly greater than in the sagittal sinus. Normal pulsatility of dural sinus blood velocity was also characterized for all measured sinuses. CONCLUSION: Characterization of variations in dural sinus velocity and flow as a function of the cardiac cycle and breathing maneuvers, using phase-contrast MR imaging, may help separate physiologic from pathologic changes of flow resulting from conditions that influence the cerebrovascular circulation.     

Intracranial venous system in the newborn: evaluation of normal anatomy and flow characteristics with color Doppler US.

To establish the effectiveness of color Doppler ultrasound (US) in identifying flow in the intracranial venous system in newborns, 20 healthy, full-term newborns were scanned. Visualization of the subependymal and internal cerebral veins, superior sagittal sinus, vein of Galen, straight sinus, and left transverse sinus was accomplished in almost every newborn (greater than or equal to 90%). Mean blood flow velocities were as follows: subependymal veins, 3.0 cm/sec; internal cerebral veins, 3.3 cm/sec; inferior sagittal sinus, 3.5 cm/sec; vein of Galen, 4.3 cm/sec; straight sinus, 5.9 cm/sec; and superior sagittal sinus, 9.2 cm/sec. Flow in the subependymal and internal cerebral veins was continuous in all but one newborn (5%), while low-amplitude pulsations were observed with increasing frequency in the more central venous structures such as the vein of Galen (15%), straight sinus (32%), and transverse sinuses (36%). It was concluded that visualization of the intracranial venous system with color Doppler US is possible in the majority of healthy neonates.     

硬脑膜窦血栓形成磁共振成像诊断

目的　总结硬脑膜窦血栓形成 (DST)头颅MRI及MRV表现特点。方法　回顾分析 2 0例DST患者的MRI及MRV表现。结果　MRI典型表现为硬脑膜窦内正常流空效应消失 ,代之以异常等信号或高信号影。病变好发部位依次为横窦 -乙状窦、上矢状窦、直窦 ,部分患者伴有皮质引流静脉及脑深部大静脉受累。MRV示受累静脉窦全程或节段性闭塞 ,病变部位和范围与MRI所见基本一致。结论　MRI及MRV可直接识别血栓 ,是目前无创性诊断DST的最可靠方法。     

2D time-of-flight MR venography in neonates: anatomy and pitfalls

BACKGROUND AND PURPOSE: The dural venous sinuses in neonates differ from those in adults or older children in that the caliber of venous sinuses is smaller and there is skull molding. The aim of this retrospective study is to evaluate the presence of flow gaps in venous sinuses in neonates on 2D time-of-flight (TOF) MR venography (MRV). METHODS: Fifty-one neonates underwent coronal 2D TOF MRV. Nine also had CT venography (CTV) for comparison. In 1 neonate, a further 2D TOF MRV was performed in the sagittal plane; in another neonate, images were captured in the axial plane; and in another, a further coronal TOF MRV with shorter echo time was performed. RESULTS: Flow gap was seen in the posterior aspect of the superior sagittal sinus in 35 of 51 (69%). Focal narrowing of the superior sagittal sinus, in the region of convergence of lambdoid sutures, was detected in 7 of 51 (14%). The right and left transverse sinuses demonstrated flow gap in 13 of 51 (25%) and 32 of 51 (63%) respectively. There was normal filling of contrast on CTV in the superior sagittal sinus, transverse sinus and sigmoid sinus in those cases with flow gap detected on coronal 2D TOF MRV. Right, left, and codominance of the transverse sinuses are as follows: 32 of 51 (63%), 5 of 51 (10%), and 14 of 51 (27%), respectively. The right and left sigmoid sinuses demonstrated flow gap in 7 of 51 (14%) and 8 of 51 (16%), respectively, and the left sigmoid sinus was absent in 1 of 51 (2%). CONCLUSION: The high proportion of flow gap in the venous sinuses of neonates, particularly of the superior sagittal sinus, could be attributed to the smaller caliber venous sinuses, slower venous flow, and skull molding.     

Computed tomographic and digital subtraction angiography evaluation of ophthalmic-ethmoidal artery dural arteriovenous fistula

Ophthalmic-ethmoidal dural arteriovenous fistula (DAVFs) is a rare type of dural arteriovenous fistulas and usually presenting with spontaneous subarachnoid hemorrhage, subdural hemorrhage or ocular symptoms. We present a case of a 59-year old gentleman presenting with acute headache, vomiting and generalized weakness. CT study of the brain revealed a large left frontal hematoma and abnormal aneurysmal sac with dilated cortical vein, communicating with the superior sagittal sinus. Conventional angiography confirmed diagnosis of ruptured ophthalmic-ethmoidal DAVF, resulting in a frontal intra-axial hemorrhage. Anterior fossa DAVFs are extremely rare, difficult to diagnose and treat. CT angiography is initial method of diagnosis, but digital substruction angiography remains the gold standard of confirming dural fistulas.     

Usefulness of MR venography in diagnosing sinus pericranii: case report

A case of sinus pericranii communicating with the superior sagittal sinus is reported. Computed tomography (CT), magnetic resonance (MR) imaging, and angiography showed characteristic findings of sinus pericranii. However, MR venography was useful to visualize the entire lesion.     

Cerebral venous thrombosis as a rare cause of subarachnoid hemorrhage: case report and literature review

We report a 48-year-old woman presenting with subarachnoid hemorrhage (SAH) as the first manifestation of superior sagittal sinus thrombosis. In a literature review of 73 cases, SAH associated with cerebral venous thrombosis (CVT) was usually seen at the cerebral convexities. SAH was adjacent to thrombosed venous structures; therefore, the most possible explanation seems to be the rupture of cortical veins due to extension of thrombosis. Computed tomography (CT) was effective for diagnosis of CVT in only 32% of the cases. CVT should be considered when SAH is limited to cerebral convexities and magnetic resonance (MR) imaging with MR venography should be performed.     

Gyral abnormalities in the early stage of superior sagittal sinus thrombosis

We report computed tomography (CT) features in a case of segmental thrombosis of the superior sagittal sinus. On the initial cranial CT scan, both frontal cortices showed focal areas of slightly increased attenuation. The lesions were isointense on magnetic resonance (MR) images no matter what pulse sequence was used, except on fluid-attenuated inversion recovery images, which showed curvilinear sulcal hyperintensity. On postcontrast T1-weighted images, curvilinearly enhancing structures were apparent in both frontal cortical sulci. No lesion appeared on follow-up CT or in MR images. We speculated that the areas of slightly increased attenuation in the cortices represented blood congestion in the cortical veins, venules and capillaries without serum leakage. Cranial CT images should be carefully interpreted to avoid overlooking subtle lesions.