摘要
目的 探讨173例症状性脑静脉窦狭窄的影像解剖特征和不同治疗方式处理脑静脉窦狭窄的有效性和可行性.方法 深圳南山医院和解放军总医院于2001年8月至2014年9月共收治脑静脉窦狭窄173例,均经全脑数字减影血管造影（DSA）造影证实.位于横窦和乙状窦交界部150例,位于上矢状窦中段18例,位于乙状窦近心段3例,直窦部2例,另外合并静脉窦憩室14例,合并Labbe＇s静脉狭窄3例.其中121例做了支架成形,52例行单纯抗凝溶栓治疗.结果 本组单纯抗凝并溶栓和支架成形的173例治疗均获成功,其中2例在经动脉溶栓中出现同侧颞枕叶出血,1例并发横窦区硬膜外血肿;经对症治疗后愈合满意.本组经门诊随访1-9年,9例头晕复发经DSA证实没有支架内再狭窄或新的血栓形成.本组有168（占97％）例静脉窦狭窄的部位在乙状窦和横窦交界区以及矢状窦中段,比较解剖学特点,此处均为脑蛛网膜颗粒的集中部位.结论 脑静脉窦狭窄和窦内蛛网膜颗粒的异常生长有关;其引发的多种神经损害可以通过单纯抗凝、溶栓或支架成形得到治愈;本组结果表明中远期的疗效较为满意.
Objective To explore the imaging anatomic features of symptomatic cerebral venous sinus stenosis, and evaluate the efficacy and feasibility of different treatment methods.Methods From August 2001 to September 2004, 173 patients （transverse sinus stenosis 150, middle of the superior sagittal sinus stenosis 18, proximal part of sigmoid sinus stenosis 3, straight sinus stenosis 2;combined with sinus diverticulum 14, combined with Labbe＇s vein stenosis 3） were confirmed venous sinus stenosis by digital subtraction angiography （DSA）.Among these patients, 121 were treated by stent implantation and the other 52 with mild symptoms by anticoagulation and/or thrombolysis treatment.Result The treatment procedures were succeeded in all patients.2 patients developed temporal and occipital hemorrhage during the procedure of artery thrombolysis, and 1 patient developed epidural hematoma in the transverse sinus area.All the 3 patients had a satisfactory prognosis through symptomatic treatment.There was no recurrence for all the patients during the follow-up period ranging from 1 to 9 years.9 patients who had recurring dizziness were confirmed no stent stenosis or thrombosis by DSA.The sites of stenosis in 168 patients （97%） were in the connect area of sigmoid and transverse sinuses or in the middle segment of superior sagittal sinus, where arachnoid granulations were focused on according to the anatomic characteristics.Conclusions There is significant correlation between the cerebral venous sinuses stenosis and the abnormal growth of arachnoid granulations in the sinuses;the neurologic deficits caused by venous sinus stenosis can be relieved and eliminated by anticoagulation, thrombolysis, or stent implantation.Favorable medium-long term outcome is showed in the study population.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2015年第43期3505-3508,共4页
National Medical Journal of China
关键词
静脉窦
狭窄
蛛网膜颗粒
支架成形
Venous sinus
Stenosis
Arachnoid granulations
Stent
