CAJ | 학술논문

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.
목적 탐토173례증상성뇌정맥두협착적영상해부특정화불동치료방식처리뇌정맥두협착적유효성화가행성.방법 심수남산의원화해방군총의원우2001년8월지2014년9월공수치뇌정맥두협착173례,균경전뇌수자감영혈관조영(DSA)조영증실.위우횡두화을상두교계부150례,위우상시상두중단18례,위우을상두근심단3례,직두부2례,령외합병정맥두게실14례,합병Labbe's정맥협착3례.기중121례주료지가성형,52례행단순항응용전치료.결과 본조단순항응병용전화지가성형적173례치료균획성공,기중2례재경동맥용전중출현동측섭침협출혈,1례병발횡두구경막외혈종;경대증치료후유합만의.본조경문진수방1～9년,9례두훈복발경DSA증실몰유지가내재협착혹신적혈전형성.본조유168(점97％)례정맥두협착적부위재을상두화횡두교계구이급시상두중단,비교해부학특점,차처균위뇌주망막과립적집중부위.결론 뇌정맥두협착화두내주망막과립적이상생장유관;기인발적다충신경손해가이통과단순항응、용전혹지가성형득도치유;본조결과표명중원기적료효교위만의.
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.