摘要：

研究背景 脑静脉窦优势引流是常见的解剖学特征，而非优势引流侧静脉窦回流缓慢导致皮质静脉血液滞留，可以造成局部脑静脉压升高和相应神经功能障碍。本文探讨非优势横窦回流异，可能出现的局限性颅内高压的诊断和抗凝治疗效果。 方法 共12 例非优势横窦回流异常患者，8 例表现为头晕、头部肿胀，2 例蛛网膜下隙出血，1 例大脑皮质出血，2 例双眼视物模糊，2 例伴同侧搏动性耳鸣，1 例有发作性睡病表现。2 例颅内压> 280 mm H₂O。9 例MRI 未见明显脑水肿及其他异常。DSA 提示10 例为左侧横窦非优势引流、2 例为右侧横窦非优势引流。所有患者均行常规抗凝治疗，其中2 例行非优势侧横窦内支架植入术、5 例行颈动脉溶栓治疗。 结果 所有患者治疗后7 d 临床症状均明显缓解，均于2 周内出院并继续抗凝治疗1 年。随访6 ~ 34 个月，可正常生活，神经功能障碍无明显加重和复发；2例6 个月后随访时复查DSA 提示非优势引流侧横窦对比剂滞留时间较前缩短。 结论 非优势横窦回流异常可以引起局部脑静脉压升高，临床表现为非特异性头晕、头痛和耳鸣。抗凝治疗、血管内溶栓和必要的支架植入术对促进局部静脉回流、减轻脑组织内潜在的血液淤滞和水肿、改善临床症状具有重要作用。

关键词: 横窦, 头晕, 磁共振成像

Abstract:

Background  Dominant venous sinus drainage of the brain is a common anatomic characteristic. Cortical venous partial retention that is due to slow non-dominant venous sinus drainage can increase local cerebral vein pressure, and cause related neurological impairment. This article is to investigate the diagnosis of local intracranial hypertension caused by abnormal non-dominant transverse sinus drainage and the effect of anticoagulation treatment. Methods From February 2008 to February 2016, there were 12 patients diagnosed as abnormal cerebral non-dominant transverse sinus drainage. Among these patients, 8 patients presented as dizziness and brain swelling; 2 presented as subarachnoid hemorrhage (SAH); one presented as cerebral cortex bleeding; 2 presented as blurred vision; 2 presented as ipsilateral pulsatile tinnitus; one presented as narcolepsy. Cerebrospinal fluid (CSF) pressure of 2 patients were > 280 mm H₂O. Nine patients were confirmed no abnormal characteristics by MRI. In DSA examination, 10 patients were confirmed non-dominant transverse sinus drainage and contrast agent retention on the left side, and 2 patients were confirmed on the right side. All patients were treated by anticoagulation, and 2 underwent stent implantation, 5 underwent thrombolysis through carotid artery.  Results  All patients were greatly improved after 7-day treatment. They were discharged within 2 weeks and were continuously treated by anticoagulation after discharge for one year. There was no recurrence or aggravation in all patients during the follow-up period ranging from 6 to 34 months. Two patients were confirmed less contrast agent retention by DSA after 6 months.  Conclusions  Abnormal non-dominant transverse sinus drainage can increase local cerebral vein pressure, and presents non-specific clinical features such as dizziness, headache or tinnitus. Anticoagulation, thrombolysis or stent implantation can promote local cerebral venous drainage, relieve potential blood stasis and edema in the brain, and improve clinical symptoms.

Key words: Transverse sinuses, Dizziness, Magnetic resonance imaging