0476脑静脉系统血栓形成-选编.ppt

● 介入治疗 ◆经皮股静脉穿刺溶栓法 ◆经颈静脉穿刺溶栓法 ◆经颅骨静脉窦插管溶栓法 ◆经前囟穿刺溶栓法 ◆微套圈辅助的直接溶栓法 ◆颈动脉穿刺溶栓法 ◆微球囊经皮腔内血管成形术 脑静脉系 血栓形成 治疗 ● 外科手术 ◆静脉窦切开血栓清除术 ◆静脉窦内插管溶栓术 ◆ Sindou横窦搭桥术 ◆静脉窦修补术 ◆ Donaphy静脉窦修补术 脑静脉系 血栓形成 治疗 ◆ CVT预后差异较大，可预测性差，部分预后较好，癫 痫发作及病情复发率均较低。 ◆近期Bruijn在对59例脑静脉窦血栓患者进行了前瞻性研 究后提出如果存在昏迷、颅内出血，则预后不良。 脑静脉系 血栓形成 预后 脑静脉 窦血栓 上矢状窦血栓 （superior sagittal sinus thrombosis，SSST） This 58 year-old man complained of a severe headache 12 hours after taking part in the London marathon. He attended the general casualty but no cause was found. He was discharged with a diagnosis of possible migraine. However, the pain persisted and he re-attended the casualty 2 days later. He was found to have bilateral optic disc swellings and an urgent MRI scan was requested. Full blood count revealed high platelet count (thrombocythemia) but otherwise all the other tests were normal 脑静脉 窦血栓 上矢状窦血栓 （superior sagittal sinus thrombosis，SSST） Clinical History: 17-year-old female who presents with a four day history of headaches and a seizure immediately prior to admission. There is no significant past medical history. Findings: An axial noncontrasted CT image through the brain demonstrates cerebral edema within the left frontal lobe and deep gray matter. In addition, there is hyperattenuation within the region of the straight sinus. Petechial hemorrhage as well as edema is seen within the left frontal lobe An angiogram demonstrates occlusion of the anterior one half of the superior sagittal sinus as well as occlusion of the deep venous system bilaterally. 脑静脉 窦血栓 上矢状窦血栓 （superior sagittal sinus thrombosis，SSST） ●预后： 单纯上矢状窦血栓在数周或数月后可再通，颅内压恢复正常，预后良好。 如果累及到其他脑静脉窦或脑静脉，而未能得到及时有效的治疗，其颅压高将持久存在，严重者可造成死亡。 脑静脉 窦血栓 上矢状窦血栓 （superior sagittal sinus thrombosis，SSST） ●横窦和乙状窦统称为侧窦。 ●病因 以耳或乳突的急慢性感染最为常见。其感染途径为： 直接途径：如中耳炎或乳突炎化脓破坏薄的骨质，而后脓肿压迫横窦，使窦内血流淤滞并伴有炎性改变。 间接途径：乳突炎或中耳炎使通向乙状窦的小静脉发生血栓，而后血栓扩展到乙状窦，开始为附壁血栓，后渐扩大为静脉窦血栓