脑乙状窦阻塞的血管内开通治疗

目的；报告l例脑乙状窦阻塞的血管内金属支架开通治疗的结果，探讨血管内支架成形术治疗脑乙状窦阻塞的方法及可行性。资料与方法：患者女性，年龄为42岁。临床表现为左侧桥脑小脑角胆脂瘤术后，出现慢性颅内高压症状，视力下降，双侧视乳头水肿，继发视神经萎缩；脑脊液压力为400mmH2O。经DSA检查确诊为脑乙状窦阻塞。开通治疗方法，经右侧股静脉途径，当导管到达阻塞段后，测压、局部给予尿激酶进行溶栓治疗。而后经右侧颈内静脉途径送入球囊导管到达乙状窦阻塞段进行扩张，置入支架。术后抗凝治疗持续3个月。结果：经动脉法脑静脉窦造影显示右侧乙状窦阻塞；双侧颈内静脉通畅。脑静脉窦测压结果，阻塞乙状窦远端压力为370mmH2O，近端压力为130mmH2O。右侧乙状窦阻塞的开通治疗成功，植入直径10mm、长度60mm支架1枚。复查直接静脉窦造影显示右侧乙状窦通畅，支架完全展开，造影剂回流通畅。开通后测压乙状窦近端、远端与颈内静脉压力相近。术后未发生严重并发症，术后第2天检查脑脊液压力为280mmH2O，头痛症状明显减轻，l周后出院。随访12个月，未再发生颅内高压症状。结论：应用血管内支架成形术治疗脑乙状窦狭窄或阻塞是一安全、简单的方法，临床疗效满意。

ENDOVASCULAR RECANALIZATION TREATMENT OF CEREBRAL SIGMOID SINUS OCCLUDED

Objective:To report the result of a case of cerebral sigmoid sinus occluded treated with endovascular recanalization with stenting and discuss the method and possibility of this therapy. Methods:We observed 42-year-old female with chronic intracanial hypertension,hypopsia, bilateral papilloedema, secondary optic atrophy after operation of left pons cerebellum keratoncus. The cerebrospinal pressure was 400 mmH 2O. DSA examination confirms diagnosis of cerebral sigmoid sinus occluded. The endovascular recanalization therapy was as follows: first, through right femoral vein we sent a catheter to the occluding to measure pressure and give urokinase locally to make thrombolysis; then,we sent the balloon catheter to the occluding through right internal jugular vein to expand and implant the stent; finally we insisted on anticoagulant therapy for three months after operation.Result: Contrast examination of cerebral venous sinus through artery angiography showed right sigmoid sinus occluded and bilateral internal jugular vein were opened. The pressures of cerebral venous sinus were 370 mmH 2O for distal pressure and 130 mmH 2O for proximal pressure. The recanalizing of right sigmoid sinus succeeded and a stent with dimension 10mm and length 60 mm was implanted. Check of venous sinus by directive contrast examination showed sigmoid sinus unobstructed, stent fully opened and contrast medium reflux easily. Measuring distal and proximal pressures of sigmoid sinus were similar after operation. Serious complication didn't occur. Cerebrospinal pressure was 280 mmH 2O after two days. Headache was clearly relieved.The patient was discharged in one week. Follow-up for 12 months, the patient didn't occur intracranial hypertension again.Conclusion:It is a safe and simple method to treat cerebral sigmoid sinus occluded and narrow by endovascular recanalization with stenting.