改良溶栓方案治疗脑静脉窦血栓形成疗效观察

目的:探讨经血管内途径治疗脑静脉窦血栓形成的48小时微量溶栓方法的疗效和安全性。方法:对22例患者进行血管内治疗。其中9例采用经典方法治疗,13例患者(9例随机分配患者及4例经典方法禁忌的患者)采用改良方法(静脉窦内留置微导管持续48h微量溶栓术)治疗。术后积极治疗原发病,抗凝治疗6个月。术后随访6～12个月,平均10±2.1月。结果:经典方法组:9例脑静脉窦血栓形成的患者,静脉窦均获得再通,其中1例植入支架1枚,2例并发脑出血(1例在右侧顶叶,1例在左侧小脑),并发脑出血的1例患者遗留面瘫,NIHSS评分1分,其余8例0分,预后良好。改良方法组:13例脑静脉窦血栓形成患者(其中含相对禁忌证病例1例,禁忌证病例3例),脑静脉窦均获得再通,无一例并发或加重脑出血,病程超过3个月的1例患者术后1个月残留语言功能障碍NIHSS评分1分,其余12例0分,预后良好。结论:经典方法可以有效治疗脑静脉窦狭窄及血栓形成,但并发脑出血的风险较大,改良方法"脑静脉窦48h微量溶栓术"有效规避了大量应用溶栓药物的问题,在达到同样疗效情况下更为安全,拓展了血管内途径治疗范围。     

孕产妇合并颅内静脉窦血栓形成的诊治体会

目的探讨孕产妇合并颅内静脉窦血栓形成的诊断和治疗。方法选择2005-05-2015-09在我院治疗的孕产妇合并颅内静脉窦血栓患者15例,回顾分析其临床资料。结果妊娠早期发病2例患者中1例经抗凝治疗后无效,转行静脉窦内接触性尿激酶溶栓治疗;妊娠晚期3例患者均行剖宫产终止妊娠,术后24h给予抗凝治疗,1例发生发生意识障碍转行血管内溶栓治疗。产褥期发病10例中经抗凝治疗无效2例,2例伴癫痫发作转行血管内溶栓治疗,1例出现颅内静脉窦广泛血栓合并脑内出血,经抢救无效死亡。结论孕产妇出现抽搐、急性和亚急性头痛等症状需警惕出现颅内静脉窦血栓,符合静脉窦引流区域的脑实质异常信号为颅内静脉窦血栓形成的诊断依据,给予抗凝和溶栓等治疗以改善孕产妇结局。     

血管内局部溶栓治疗颅内静脉窦血栓

目的评价局部溶栓与机械碎栓治疗静脉窦血栓的影像学资料与治疗效果。方法对7例静脉窦血栓病人经股静脉穿刺,将微导管选择性插入已闭塞的静脉窦内。6例行静脉窦局部灌注尿激酶或基因重组组织型纤溶酶原激活剂,1例采用球囊机械碎栓术;3例伴脑皮质或深部静脉血栓者同时经颈动脉给予溶栓药。结果造影示6例已闭塞的静脉窦部分再通,1例无明显再通;3例侧支静脉回流增多。1例溶栓后原有脑内血肿增大,导致偏瘫加重;1例术后发生无症状出血性静脉梗死。随访10个月~3年,6例mRankin评分0~1分,1例mRankin评分2分。结论血管内局部溶栓治疗静脉窦血栓,静脉窦完全再通率低,但血管部分再通及侧支静脉回流增多,可改善病人的临床预后。     

脑静脉窦血栓的综合血管内治疗

目的评价综合应用颈动脉溶栓、静脉窦置管溶栓及静脉窦支架置入术治疗脑静脉窦血栓的疗效。方法对我科1997年7月～2005年6月收治的99例脑静脉窦血栓患者进行综合血管内治疗,其中5例患者接受静脉窦置管溶栓合并静脉窦支架置入术(方案1),38例患者接受颈动脉溶栓合并静脉窦置管溶栓(方案2),56例患者接受单纯颈动脉溶栓(方案3),观察3组患者的临床疗效。结果经治疗,99例患者中有94例颅内压降至300 mm H_2O, 75例患者静脉窦实现再通,93例患者循环时间降至11 s以下。结论综合应用颈动脉溶栓、静脉窦置管溶栓及静脉窦支架置入术等方法治疗脑静脉窦血栓是一种安全、有效的手段。     

脑静脉窦血栓的局部溶栓治疗及随访分析

目的评估脑静脉窦血栓局部溶栓治疗的效果。方法脑静脉窦血栓13例经股动脉插管,行全脑血管造影。明确诊断后,经股静脉插管,微导管超选至血栓内局部溶栓。术后抗凝治疗。3～62个月,进行改良Rankin评分（mRS）,5例行MRI随访。结果 12例治疗后症状缓解或消失,1例死亡。1例复发再次局部溶栓治疗,其余病例疗效满意。结论局部溶栓治疗脑静脉窦血栓安全有效。     

脑静脉窦血栓血管内治疗的临床分析

目的应用经颈动脉溶栓、静脉窦置管溶栓、静脉窦球囊扩张术和静脉窦支架植入术治疗脑静脉窦血栓,探讨血管内治疗的适应证及疗效。方法分别采用单纯经颈动脉溶栓(方案1)、经颈动脉溶栓并静脉窦置管溶栓(方案2)、经颈动脉溶栓并静脉窦置管溶栓、静脉窦球囊扩张术(方案3)及经颈动脉溶栓并静脉窦置管溶栓、静脉窦支架植入术(方案4)综合治疗104例脑静脉窦血栓患者,观察4种治疗方案的临床疗效。结果治疗后,所有患者脑循环时间均降至<14s,颅内压由治疗前的(350.29±80.12)mmH2O降至(247.92±75.53)mmH2O,组间差异具有统计学意义(t=83.670,P=0.000)。应用改良Rankin量表评价患者预后,0级71例(68.27%),1级26例(25.00%),2级6例(5.77%),3级1例(0.96%),4级0例,5级0例,4种治疗方案组之间差异无统计学意义(Z=13.150,P=0.065)。结论脑静脉窦血栓的血管内治疗安全、有效,经颈动脉溶栓与静脉窦置管溶栓、静脉窦球囊扩张术及静脉窦支架植入术联合应用,可提高治疗慢性、多发性脑静脉窦血栓的疗效。     

上矢状窦远端置管持续尿激酶泵入接触性溶栓治疗颅内静脉窦血栓形成(9例报道)

目的 探讨上矢状窦远端置管持续尿激酶泵入接触性溶栓治疗颅内静脉窦血栓形成的疗效和安全性. 方法 聊城市人民医院神经内科自2008年1月至2011年1月对9例难治性颅内静脉窦血栓形成患者进行了上矢状窦远端置管持续尿激酶泵入接触性溶栓治疗,辅以机械性血栓切割,以血栓全部或大部分溶解、闭塞的脑静脉窦主干再通为停止溶栓指征.术后积极治疗原发病及抗血小板聚集治疗6个月.出院后随访9～30个月,内容包括腰穿、眼底检查和MRV或DSA检查. 结果 出院时9例患者的闭塞静脉窦均再通,动静脉循环时间正常,皮层静脉和深静脉恢复正常,临床症状改善,颅内压恢复,眼底水肿明显减轻或消失,GCS评分由术前平均10分恢复到15分,未出现与血管内治疗相关的并发症;平均随访20个月后无一例患者血栓再形成,未出现新的神经功能缺失症状. 结论 上矢状窦远端置管持续尿激酶泵入接触性溶栓治疗颅内静脉窦血栓形成是一种安全、有效的治疗手段.     

尿激酶静脉溶栓后早期血管再闭塞的原因分析

目的 探讨尿激酶静脉溶栓后早期血管再闭塞的原因.方法 对16例大脑中动脉闭塞后应用尿激酶静脉溶栓的患者,治疗前行经颅多普勒(TCD)及颈动脉超声检查,溶栓治疗开始后行TCD监测并且持续2h,如溶栓后2～24h内临床症状恶化而头颅CT无脑出血,则再次行TCD检查,溶栓前及溶栓后24h内行NIHSS评分.结果 尿激酶静脉溶栓2h后,血管再通率为68.8%,早期血管再闭塞率为18.8%,溶栓前NIHSS评分＞16分及合并同侧颅外颈动脉高度狭窄为再闭塞的预测因素.结论 溶栓前脑梗死的严重程度及合并同侧颅外颈动脉严重狭窄能预测尿激酶静脉溶栓后早期血管再闭塞.     

联合治疗方案与全身抗凝治疗脑静脉窦血栓形成

目的 比较脑静脉窦血栓形成的联合治疗方案与全身抗凝在临床应用中的有效性和安全性.方法 网顾性连续收集脑静脉窦血栓形成116例患者资料,根据治疗方式不同分为联合治疗组30例和全身抗凝组86例.其中联合治疗组在全身抗凝的基础上,接受改良溶栓方案介入治疗,即脑动脉及静脉窦造影明确诊断后行机械性破栓及吸栓术,于静脉窦内留置微导管行尿激酶微量泵点接触性溶栓.采用NIHSS评分对两组患者治疗前后神经功能缺损评分,应用改良Rankin量表(mRS)评价出院时情况.结果 联合治疗组30例,男9例;全身抗凝组86例,男23例.治疗前神经功能缺损:联合治疗组0～19分,全身抗凝组0～17分,差异无统计学意义(Z=-0.474,P=0.636);治疗后联合治疗组神经功能缺损程度减轻,出院时mRS评分较低,两组颅内出血发生率差异无统计学意义.结论 联合治疗较全身抗凝有利于神经功能恢复.两种治疗方法颅内出血发生率无明显差异.     

重症脑静脉与静脉窦血栓形成超选择窦内碎栓、溶栓治疗的护理

目的探讨重症脑静脉窦血栓形成超选择窦内碎栓、溶栓治疗的护理要点。方法 2011年1月至2013年1月收治12例重症脑静脉与静脉窦血栓形成患者,全脑血管造影确诊后行静脉窦超选择碎栓、溶栓治疗。结果除1例死亡外,其余11例治愈出院。结论对于重症脑静脉与静脉窦血栓形成患者,通过进行全脑血管造影明确诊断后行碎栓、溶栓治疗,术后严密观察病情、生命体征的变化,合理应用溶栓和抗凝药物,严密监测凝血指标,做好动脉导管鞘的护理,可使患者的病情得到有效的控制。     

Superior Sagittal Sinus Thrombosis in the Presence of Idiopathic Bilateral Internal Jugular Vein Stenosis

Cerebral venous outflow obstruction and anomalies in cerebral venous circulation predispose to dural sinus thrombosis. This case report illustrates the magnetic resonance and angiographic findings in a patient who had superior sagittal sinus thrombosis secondary to idiopathic bilateral internal jugular vein stenosis, a previously unrecognized entity. The findings suggest that bilateral stenosis of the internal jugular veins at their junction with the innominate veins causes obstruction to cerebral venous outflow leading to dural sinus thrombosis.     

Vernet's Syndrome Associated with Internal Jugular Vein Thrombosis

Our objective is to present a case of Vernet's syndrome (cranial nerve (CN) IX, X, and XI palsy) associated with cerebral venous thrombosis (CVT) in an internal jugular vein. The patient presented with acutely developed dysphagia. The weakness of the left sternocleidomastoid and trapezius muscles was observed. The initial magnetic resonance imaging and computed tomography (CT) with contrast enhancement showed contrast-filling defect in the left internal jugular vein inside the jugular foramen. The magnetic resonance venography with contrast enhancement revealed a partial filling defect in the left sigmoid sinus and total occlusion of the left internal jugular vein. Under the diagnosis of CVT associated with CN IX, X palsy, anticoagulation therapy with low-molecular-weighted heparin was initiated. Despite the continued anticoagulation therapy for 3 months, neither the burden of thrombosis in the left sigmoid sinus and internal jugular vein on neck CT nor dysphagia symptoms improved. Clinicians need to be aware of internal jugular venous thrombosis as one of the differential diagnoses in Vernet's syndrome in patients in a hypercoagulable state. Further reporting of similar cases is needed to confirm the association between CVT and Vernet's syndrome.     

Thrombus of the left lateral sinus spreading to the internal jugular vein

Cerebral venous thrombosis is an uncommon event which presents a wide spectrum of sometimes extraneurological signs different from the classical clinical presentation. We report the cases of two middle-aged women who developed thrombosis of the left lateral sinus spread-ing to the internal jugular vein from the sigmoid sinus. The time course of the symptoms suggested that intracranial thrombosis occurred first. No infectious or neoplastic local disease could be found but both women were taking oral contraceptives. Medical treatment led to good reperfusion of the intracranial sinuses but occlusion of the jugular vein persisted despite prolonged oral anticoagulants. Long-term outcome was favorable with residual benign epilepsy in one patient, and occurrence of an arteriovenous fistula in the other.     

MRI和MRV在脑静脉和静脉窦血栓诊断中的价值

目的探讨MRI和MRV对脑静脉和静脉窦血栓(CVST)形成的诊断价值。方法回顾性分析16例CVST患者的临床和影像学资料。结果受累的脑静脉和静脉窦有上矢状窦9例,横窦5例,直窦3例,乙状窦2例,大脑大静脉合并大脑内静脉2例。常规MRI可见受累静脉窦流空信号消失,静脉窦内信号高低不一,11例脑实质内出现静脉性脑梗死表现,其中4例合并出血。增强扫描15例静脉窦内出现充盈缺损及静脉窦壁强化表现,9例脑实质内出现脑回样强化。MRV表现为受累静脉窦部分或广泛高血流信号缺失、狭窄。结论MRI和MRV是诊断和随访CVST形成的最佳检查方法。     

Massive cerebral venous thrombosis associated with the bilateral catheterization of the internal jugular veins: a case report

The authors describe the occurrence of the thrombosis of the cerebral venous sinuses in a patient in coma due to a large hemispheric infarction attributed to the thrombosis of the left internal carotid artery. After his admission to the Intensive Care Unit, a fiberoptic catheter was advanced into the left internal jugular vein to monitor the jugular bulb blood oxygen saturation, and the controlater was catheterized In order to supply fluids and medications. Despite the aggressive treatment, the patient died and, at the autopsy a massive thrombosis of the internal jugular veins was found, which extended to all the sinuses, in the absence of evident carotideal abnormalities. The authors describe the possible mechanisms of the massive thrombosis.     

Unusual Intracranial Parasagittal Meningioma Extending into the Internal Jugular Vein through the Sinuses

Meningiomas frequently invade cerebral venus sinuses, especially parasagittal meningioma to superior sagittal sinus. However, most invasions do not reach internal jugular vein. We present a case of parasagittal meningioma extending into the internal jugular vein through the sinuses. Radiological investigation revealed that the tumor was invading the sagittal, transverse, sigmoid sinus and junction of the internal jugular vein to subclavian vein, which was filled with tumor. The histopathological examinations revealed that both the cerebral tumor and mass in the internal jugular vein contributed to the transitional meningioma. This is a rare case of a meningioma extending into the internal jugular vein through the sinuses. According to this case, the frontal parasagittal meningioma could invade directly the internal jugular vein. The significance of this association to cerebral venus sinuses and internal jugular vein are discussed.     

An unusual case of neuro-Behçet’s disease presenting with co-occurence of cerebral venous sinus thrombosis with basilar artery occlusion

Non-parenchymal neuro-Behçet disease generally affects cerebral venous sinuses, whereas intracranial intracerebral arterial involvement has been rarely reported. But co-involvement of both intracranial intracerebral artery and venous vascular systems in a patient at the same time has not been mentioned before. To the best of our knowledge, this case involving a 25-year-old male with a 7-year history of Behçet disease is the first reported of this type of involvement. He developed occlusion of the basilar artery together with thrombosis of the left sigmoid sinus, distal internal jugular vein, and straight sinus. He was successfully treated with a combination of high-dose steroid and cyclophosphamide. Cranial magnetic resonance angiography demonstrated the resolution of these abnormalities.     

颈静脉孔区颅内静脉窦血管造影及临床意义分析

研究背景通过综合分析颈静脉孔区颅内静脉窦血管造影术影像学表现,探讨颅内静脉窦支架植入困难或失败原因,并寻找可预测静脉窦狭窄支架植入困难的临床指标,以提高手术成功率。方法对118例接受颅内静脉窦支架植入术患者(窦狭窄伴颅内高压87例、窦狭窄致搏动性耳鸣31例)的临床资料进行回顾,分析颈静脉孔区静脉窦两个转折夹角及静脉窦直径对支架植入技术成功的影响。结果共115例患者术中支架植入成功、3例因支架植入困难而导致手术失败。颈静脉孔区静脉窦为连接乙状窦和颈内静脉的过渡结构,侧位脑血管造影呈典型"N"形结构,支架植入成功者静脉窦两个转折夹角之和为(120.11±30.32)°、失败者为(86.37±10.72)°,二者差异有统计学意义(t=23.420,P=0.001);静脉窦直径分别为(5.10±1.12)和(5.11±0.37)mm,差异无统计学意义(t=7.210,P=0.352)。结论颈静脉孔区静脉窦侧位脑血管造影呈"N"形结构,若静脉窦两转折夹角过小易导致支架植入困难,但静脉窦直径不影响支架的植入。     

Early Spontaneous Recanalization of Sigmoid Sinus Thrombosis Following a Closed Head Injury in a Pediatric Patient : A Case Report and Review of Literature

Cerebral venous sinus thrombosis (CVST) following a closed head injury in pediatric patients is a rare condition, and an early spontaneous recanalization of this condition is extremely rare. A 10-year-old boy was admitted with a mild, intermittent headache and nausea five days after a bicycle accident. The brain computed tomography showed an epidural hematoma at the right occipital area with pneumocephalus due to a fracture of the occipital skull bone. The brain magnetic resonance imaging and the magnetic resonance venography demonstrated a flow signal loss from the right sigmoid sinus to the right jugular vein. The diagnosis was sigmoid sinus thrombosis, so close observations were selected as a treatment for the patient because of his gradually improving symptoms; however, he complained of vomiting 14 days the after conservative treatment. The patient was readmitted for a further examination of his symptoms. The laboratory and the gastroenterological examinations were normal. Due to concern regarding the worsening of the sigmoid sinus thrombosis, the brain magnetic resonance venography was rechecked and it revealed the recanalization of the venous flow in the sigmoid sinus and in the jugular vein.