外伤性颅内静脉窦血栓诊治体会

目的 探讨外伤性颅内静脉窦血栓形成的诊断及治疗方法。 方法 回顾性分析经临床和影像学方法确诊的13例外伤性颅内静脉窦血栓形成患者资料，其中行血肿清除及去骨瓣手术3例，采取早期抗凝、静脉溶栓2例，静脉窦接触性溶栓介入治疗2例，病程较长、保守治疗效果不理想者行侧脑室—腹腔分流手术1例，余5例横窦栓塞患者没有症状或者症状轻微，行保守治疗。 结果 13例患者中10例治愈，2例存在局灶性症状，1例轻度智力障碍。术后3d～6个月8例复查DSA，3～6个月5例复查MRV，均通畅。结论外伤性颅内静脉窦血栓形成一旦确诊应尽早积极治疗，抗凝和溶栓治疗是目前主要治疗方法。

Diagnosis and treatment of traumatic cerebral venous sinus thrombosis

Objective To investigate the diagnosis and treatment of intracranial venous sinus thrombosis caused by trauma. Methods The clinical data of 13 patients had definite diagnosis by clinic and imaging, were analyzed retrospectively. Three patients received removal of hematoma and bone flap operation; 2 received anticoagulant therapy in early phase and intravenous thrombolysis; 2 accepted intrasinus interventional catheter-directed thrombolysis; ventriculoperitoneal shunt operation was performed in 1 patient for enjoying sub-optimal effects of conservative treatment; and the other 5 patients with transverse sinus embolism accepted conventional treatment for their symptom-free or having mild symptom. Results Intracranial venous sinus thrombosis caused by trauma was likely to locate in the superior sagittal sinus and transverse sinus; these patients mostly manifested as severe diffuse brain swelling combined with a fractured skull, epidural hematoma or intracerebral hematoma. Ten patients got clinical cure, 2 focal symptom and 1 mild mental retardation. Three days to 6 months after treatment, good results were noted in 8 patients performed DSA and in 5 patients performed MRV. Conclusion Early treatment should be given once the definite diagnosis is made in patients with intracranial venous sinus thrombosis caused by trauma, and anticoagulant and thrombolytic therapy are the main methods.