摘要： 目的 探讨“橄榄头”技术用于脑静脉窦狭窄支架植入术的临床价值。方法 回顾分析2017年1月至2021年5月在解放军总医院第一医学中心因脑静脉窦狭窄接受支架植入术治疗的79例患者（伴颅内高压57例、搏动性耳鸣22例）的临床资料，分析“橄榄头“技术组患者Labbe静脉特点、颅内高压患者手术前后狭窄段两端压力差变化，观察术后狭窄改善程度、静脉回流情况、颅内高压和搏动性耳鸣改善情况、支架植入术成功率和“橄榄头”技术使用率。结果 79例患者手术成功率为100%，术后即刻DSA显示残留狭窄率< 30%、无Labbe静脉滞留。23例（29.11%）因导引导管及支架到位困难采用“橄榄头”技术协助支架顺利到位，其Labbe静脉与静脉窦汇合点直径均大于常规技术患者（t=7.041，P=0.000）。57例颅内高压患者手术前后脑静脉窦狭窄段两端的压力差分别为15.00（11.00，21.50）和1（0，2）mm Hg，二者差异有统计学意义（Z=- 6.573，P=0.000）；22例搏动性耳鸣患者术后症状消失或明显好转。结论 Labbe静脉与静脉窦汇合点直径可以作为脑静脉窦支架植入术前评估支架是否到位困难的指标。扩张的Labbe静脉汇入口易导致导引导管及支架卡顿，支架到位困难，采用”橄榄头“技术可明显提高手术成功率。

关键词: “橄榄头”技术(非MeSH词), 缩窄,病理性, 脑静脉, 颅窦, 支架

Abstract: Objective To explore the clinical significance of "Olive-Tipped" cerebral venous sinus stenosis stenting. Methods A total of 79 patients (including 57 patients with intracranial hypertension and 22 patients with pulsatile tinnitus) who were diagnosed with cerebral venous sinus stenosis (VSS) and underwent stenting in Department of the First Medical Center of Chinese PLA General Hospital from January 2017 to May 2021 were retrospectively collected. The characteristics of Labbe vein in patients with "Olive-Tipped" technique, the changes of pressure difference at both ends of stenosis before and after surgery in patients with intracranial hypertension were analyzed. The improvement of postoperative stenosis and venous reflux, the improvement of postoperative intracranial hypertension and pulsatile tinnitus, the success rate of stenting and the utilization rate of "Olive-Tipped" technique were observed. Results All the stents were successfully placed (79/79). Immediate DSA after procedure showed no venous stasis in all patients, and residual stenosis was < 30%. "Olive-Tipped" technique was used in 23 patients (29.11%) to assist the stent in place due to the guiding catheter and stent could not reach the predetermined position smoothly. The diameter of the confluence of Labbe vein and venous sinus in the "Olive-Tipped" technique group was significantly larger than that in the conventional technique group (t=7.041, P=0.000). The pressure difference between the two ends of venous sinus stenosis in patients with intracranial hypertension was 15.00 (11.00, 21.50) mm Hg before surgery and 1 (0, 2) mm Hg immediately after surgery, the difference was statistically significant (Z=-6.573, P=0.000). The tinnitus sympoms of 22 patients with pulsatile tinnitus caused by cerebral venous sinus stenosis disappeared immediately or visibly lightened. Conclusions The diameter of the confluence of Labbe vein and venous sinus can be used as an index to evaluate whether the stent is easy to implant before the surgery. The dilated Labbe vein confluence is easy to cause the guiding catheter and stent to get stuck, and the stent is difficult to be in place. The use of "Olive-Tipped" technique can significantly improve the success rate of the surgery.

Key words: Olive-Tipped technique (not in MeSH), Constriction, pathologic, Cerebral veins, Cranial sinuses, Stents