摘要
目的:总结重型单侧横窦、乙状窦血栓形成的影像学特征并评估其血管内介入治疗的疗效及安全性。方法:回顾性收集郑州大学第一附属医院放射介入科自2012年6月至2022年9月收治的37例以颅内高压症状为主要临床表现并行血管内介入治疗的重型单侧横窦、乙状窦血栓形成患者的临床资料,总结其影像学特征,依据患者手术前后闭塞静脉窦内血流复通、压力降低程度及神经症状改善情况评价近期疗效,统计住院期间并发症发生情况,依据术后临床随访及6~12个月的影像学随访结果评价手术安全性和远期疗效。结果:(1)术前头颅MRI和(或)CT显示患者脑组织不同程度的肿胀,以患侧为著,同时闭塞的横窦、乙状窦内可见混杂信号/密度影,部分患者可同时合并静脉性脑梗死或梗死后脑出血表现;MRV、CTV和DSA显示患侧横窦、乙状窦显影较差或完全闭塞而对侧显影正常,闭塞的静脉窦机械开通后其内可见明显的血栓充盈缺损影。(2)术后所有患者的闭塞静脉窦内血流均得到复通,闭塞段压力梯度差由术前的(16.6±3.3) mmHg降至术后的(2.8±0.8) mmHg。出院前所有患者的临床症状均得到明显改善[改良Rankin量表(mRS)评分0分30例、1分5例、2分1例和3分1例],2例患者遗留单侧肢体活动障碍(肌力分别为Ⅲ级和Ⅳ级)。所有患者均获得临床随访,随访时间为(9.6±3.0)个月,末次随访时神经功能均较术前有明显改善,且无新发神经系统相关症状(mRS评分0分30例、1分6例、2分1例)。34例患者获得MRV或DSA随访,28例患者的闭塞静脉窦完全再通,6例患者部分再通,均未见明显狭窄或闭塞复发。结论:重型单侧横窦、乙状窦血栓形成可致局部颅内静脉内血液瘀滞,进而引起"静脉窦区域性压力增高",表现为单侧脑组织肿胀甚至静脉性脑梗死或梗死后脑出血等影像学改变。早期诊断并积极行血管内介入治疗能显著改�
Objective To summarize the imaging features of severe unilateral transverse sinus and sigmoid sinus thromboses,and evaluate the efficacy and safety of intravascular interventional therapy in them.Methods Thirty-seven patients with severe unilateral transverse sinus and sigmoid sinus thromboses clinically mainly manifested as intracranial hypertension and accepted endovascular intervention in Department of Interventional Radiology,First Affiliated Hospital of Zhengzhou University from June 2012 to September 2022 were chosen;their clinical data were retrospectively analyzed and imaging features were summarized.Short-term efficacy was evaluated according to blood flow restoration degrees and pressure gradient reduction in the occlusive sinus and modified neurological symptoms before and after endovascular intervention.Hospitalized complications were observed;safety and long-term efficacy were evaluated according to postoperative clinical follow-up and imaging results 6-12 months after endovascular intervention.Results(1)Preoperative brain MRI and(or)CT showed different degrees of swelling of the brain tissues,with the affected side as the target;mixed signals/density shadow could be seen in the blocked transverse sinus and sigmoid sinus;venous cerebral infarction or post-infarction cerebral hemorrhage could be combined in some patients.MRV,CTV and DSA showed poor or completely occluded transverse sinus and sigmoid sinus while normal in the contralateral side;obvious thrombus filling-defect was observed in the occluded venous sinus after mechanical thrombolysis.(2)Occlusive sinus blood flow was restored in all patients after endovascular intervention,and pressure gradient of the occlusive segment decreased from(16.6±3.3)mmHg before to(2.8±0.8)mmHg after endovascular intervention.Before discharge,clinical symptoms of all patients were significantly improved(modified Rankin scale[mRS]scores of 0 in 30 patients,1 in 5 patients,2 in 1 patient and 3 in 1 patient),and 2 patients had unilateral limb movement disorder(musc
作者
李腾飞
田奇
史帅龙
杨杰
王晔
陈振
冉云彩
文宝红
郭栋
水少锋
韩新巍
李晓
马骥
Li Tengfei;Tian Qi;Shi Shuailong;Yang Jie;Wang Ye;Chen Zhen;Ran Yuncai;Wen Baohong;Guo Dong;Shui Shaofeng;Han Xinwei;Li Xiao;Ma Ji(Department of Interventional Radiology,First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Neurointervention,First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Magnetic Resonance,First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)
出处
《中华神经医学杂志》
CAS
CSCD
北大核心
2024年第1期42-47,共6页
Chinese Journal of Neuromedicine
基金
河南省中青年卫生健康科技创新杰出青年人才培养项目(YXKC2022029)
河南省高等学校重点科研项目(24A320038)。
关键词
颅内静脉窦血栓形成
横窦
乙状窦
血管内介入治疗
影像学特征
Intracranial venous sinus thrombosis
Transverse sinus
Sigmoid sinus
Endovascular intervention
Imaging feature
