重症脑静脉窦血栓形成血管内治疗预后分析

doi:10.3969/j.issn.1672-6731.2025.06.007

中国现代神经疾病杂志 ›› 2025, Vol. 25 ›› Issue (6): 496-502. doi: 10.3969/j.issn.1672-6731.2025.06.007

2 重症脑静脉窦血栓形成血管内治疗预后分析

聂放¹, 蔡恒², 唐伟², 李进伟¹, 付开磊¹, 李志清¹^,*()

1. 110001 中国医科大学附属第一医院卒中中心辽宁省神经疾病大数据重点实验室辽宁省沈阳市神经系统疑难重症临床医学研究中心
2. 110004 沈阳, 中国医科大学附属盛京医院神经外科

收稿日期:2025-04-10 出版日期:2025-06-25 发布日期:2025-07-04
通讯作者: 李志清
作者简介:
聂放与蔡恒对本文有同等贡献

NIE Fang and CAI Heng contributed equally to the article
基金资助:
四大慢病重大专项(2023ZD0505600); 四大慢病重大专项(2023ZD0505603); 辽宁省自然科学基金计划指导计划项目(2019-ZD-0757); 辽宁省沈阳市科技计划项目(21-172-9-17)

Prognostic analysis of endovascular treatment for severe cerebral venous sinus thrombosis

Fang NIE¹, Heng CAI², Wei TANG², Jin-wei LI¹, Kai-lei FU¹, Zhi-qing LI¹^,*()

1. Stroke Center; Key Laboratory of Neurological Disease Big Data of Liaoning Province; Shenyang Clinical Medical Research Center for Difficult and Serious Diseases of the Nervous System, The First Hospital of China Medical University, Shenyang 110001, Liaoning, China
2. Department of Neurosurgery, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning, China

Received:2025-04-10 Online:2025-06-25 Published:2025-07-04
Contact: Zhi-qing LI
Supported by:
Noncommunicable Chronic Diseases-National Science and Technology Major Project(2023ZD0505600); Noncommunicable Chronic Diseases-National Science and Technology Major Project(2023ZD0505603); Natural Science Foundation of Liaoning(2019-ZD-0757); Shenyang Science and Technology Bureau in Liaoning(21-172-9-17)

摘要/Abstract

摘要：

目的: 探讨重症脑静脉窦血栓形成血管内治疗效果和预后，为疾病治疗提供新思路。方法: 回顾分析2017年10月至2024年12月中国医科大学附属第一医院和中国医科大学附属盛京医院诊断与治疗的31例重症脑静脉窦血栓形成患者的临床经过，通过术后即刻DSA评估静脉窦再通情况，选择围手术期并发症发生率、随访期间病死率和末次随访时改良Rankin量表（mRS）评分等多项标准评价患者预后。结果: 采用多种血管内治疗技术联合应用方式，术后即刻达到静脉窦完全再通者7例（22.58%）、部分再通24例（77.42%）。围手术期并发症发生率为6.45%（2/31），无新发脑梗死。平均随访（6.60 ± 3.40）个月，随访期间无死亡病例，末次随访时预后良好（mRS评分≤ 2分）者28例（90.32%）。结论: 血管内治疗可以有效降低重症脑静脉窦血栓形成患者病死率并改善预后，但治疗需基于个体化评估，严格掌握适应证。

关键词: 窦血栓形成，颅内, 危重病, 血栓切除术, 血栓溶解疗法, 抗凝药, 预后

Abstract:

Objective: To explore the efficacy and prognosis of endovascular treatment for severe cerebral venous sinus thrombosis (CVST), providing new insights for the treatment of CVST. Methods: The clinical course of 31 severe CVST patients admitted to The First Hospital of China Medical University and Shengjing Hospital of China Medical University from October 2017 to December 2024 was analyzed retrospectively. The condition of venous sinus recanalization was assessed through immediately postoperative DSA examination, and the prognosis was evaluated based on criteria such as perioperative complication rate, mortality rate during follow‐up, and modified Rankin Scale (mRS) score at the last follow‐ up. Results: A combination of multiple endovascular treatment techniques was used. Immediately after the operation, 7 patients (22.58%) achieved complete recanalization of the venous sinus and 24 patients (77.42%) achieved partial recanalization. The incidence of perioperative complication rate was 6.45% (2/31), and there was no new cerebral infarction. The average follow ‐ up period was (6.60 ± 3.40) months. No deaths were reported during the follow ‐ up period. At the last follow ‐ up, 28 patients (90.32%) had a good prognosis (mRS score ≤ 2). Conclusions: Endovascular treatment can effectively reduce the mortality rate and improve the prognosis of patients with severe CVST, but individualized assessment is required, and indications must be strictly controlled.

Key words: Sinus thrombosis, intracranial, Critical illness, Thrombectomy, Thrombolytic therapy, Anticoagulants, Prognosis

聂放, 蔡恒, 唐伟, 李进伟, 付开磊, 李志清. 重症脑静脉窦血栓形成血管内治疗预后分析[J]. 中国现代神经疾病杂志, 2025, 25(6): 496-502.

Fang NIE, Heng CAI, Wei TANG, Jin-wei LI, Kai-lei FU, Zhi-qing LI. Prognostic analysis of endovascular treatment for severe cerebral venous sinus thrombosis[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2025, 25(6): 496-502.

https://journal11.magtechjournal.com/cjcnn/CN/Y2025/V25/I6/496

图/表 2

图 1 男性患者，19岁，因头痛5 d，加重伴抽搐、右侧肢体无力、意识不清1 d入院。临床诊断为脑静脉窦血栓形成，行支架取栓联合抽吸取栓。手术前后头部影像学检查所见 1a 术前CT显示双侧额顶叶肿胀，呈混杂密度影，病灶内可见出血（箭头所示） 1b 术前右颈内动脉造影静脉期显示上矢状窦闭塞（白色箭头所示），右侧横窦（黑色粗箭头所示）、乙状窦（黑色细箭头所示）显影不良 1c 术后即刻右颈内动脉造影静脉期显示上矢状窦和右侧横窦、乙状窦、颈内静脉完全再通 1d 术后14 d复查CT显示双侧额顶叶肿胀明显减轻，出血部分吸收 1e，1f 术后14 d复查MRV显示上矢状窦、下矢状窦、右侧横窦、乙状窦、直窦及窦汇通畅，左侧颈内静脉、乙状窦显影不清

Figure 1 A 19-year-old male patient was admitted to hospital due to headache for 5 d, with aggravating accompanied with convulsions, weak right limbs, and unclear consciousness for 1 d. He was clinically diagnosed CVST and was received stent combined aspiration thrombectomy to remove the thrombus. Pre- and post- operative head imaging findings Preoperative CT showed swelling in bilateral frontal and parietal lobes, with mixed density shadows and bleeding within the lesion (arrows indicate, Panel 1a). Preoperative lateral DSA showed occlusion of the superior sagittal sinus (white arrow indicates) and poor visualization of the right transverse sinus (black thick arrow indicates) and the sigmoid sinus (black thin arrow indicates, Panel 1b). Immediately postoperative lateral DSA showed complete recanalization of the superior sagittal sinus, right transverse sinus, sigmoid sinus, and internal jugular vein (Panel 1c). Postoperative 14 d CT showed significant reduction in bilateral frontal and parietal lobes swelling compared to before, with partial absorption of bleeding (Panel 1d). Postoperative 14 d MRV showed the superior sagittal sinus, the inferior sagittal sinus, the right transverse sinus, the sigmoid sinus, the straight sinus, and the confluence of sinus were unobstructed, while the left internal jugular vein and sigmoid sinus were not clearly visualizate (Panel 1e, 1f).

图 2 男性患者，24岁，因头痛6 d，右侧肢体活动不便、意识不清伴抽搐3 d入院。临床诊断为脑静脉窦血栓形成并发脑出血，行支架取栓联合抽吸取栓。手术前后头部影像学检查所见 2a 术前横断面DWI显示双侧顶叶肿胀伴多发异常高信号影（箭头所示） 2b，2c 术前CT显示双侧额顶叶弥漫性肿胀伴病灶内多发出血灶（箭头所示） 2d 术中右颈内动脉造影静脉期显示上矢状窦远端1/3、上矢状窦近窦汇处、右侧横窦、乙状窦和颈内静脉远端闭塞，提示血栓形成 2e 术中左颈内动脉造影静脉期显示上矢状窦、左侧横窦、乙状窦和颈内静脉闭塞 2f 术中DSA可见支架在上矢状窦血栓远端释放锚定后抽吸导管从左颈内静脉前进 2g 术后即刻左颈内动脉造影静脉期显示上矢状窦部分再通，左侧横窦、乙状窦和颈内静脉完全再通 2h 术后15 d复查增强MRV显示上矢状窦部分再通，有残留狭窄 2i 术后1年左颈内动脉造影静脉期显示上矢状窦部分再通伴局部狭窄，左侧横窦、乙状窦和颈内静脉完全再通

Figure 2 A 24-year-old male patient was admitted to hospital due to headache lasting for 6 d, right hemiplegia, confusion with convulsions for 3 d. He was clinically diagnosed CVST combined with intracerebral hemorrhage, and stent combined aspiration thrombectomy to remove the thrombus. Pre- and post - operative head imaging findings Preoperative axial DWI showed bilateral parietal lobes swelling with multiple abnormal hyperintensity (arrows indicate, Panel 2a). Preoperative CT showed diffuse swelling of bilateral frontal and parietal lobes with multiple bleeding foci within the lesion (arrows indicate; Panel 2b, 2c). Intraoperative lateral DSA showed 1/3 of the distal end of superior sagittal sinus, the proximal end of the superior sagittal sinus, the right transverse sinus, sigmoid sinus, and the distal end of internal jugular vein occlusion, indicating thrombosis (Panel 2d). Intraoperative lateral DSA showed the superior sagittal sinus, the left transverse sinus, sigmoid sinus, and internal jugular vein occlusion (Panel 2e). Intraoperative DSA showed the stent released and anchored at the distal end of the superior sagittal sinus thrombus, and the aspiration catheter advanced from the left internal jugular vein (Panel 2f). Immediately postoperative lateral DSA showed partial recanalization of the superior sagittal sinus, complete recanalization of the left transverse sinus, sigmoid sinus and internal jugular vein (Panel 2g). Postoperative 15 d enhanced MRV showed partial recanalization of the superior sagittal sinus, with residual stenosis (Panel 2h). Postoperative one year lateral DSA showed partial recanalization of the superior sagittal sinus with residual stenosis, complete recanalization of the left transverse sinus, sigmoid sinus and internal jugular vein (Panel 2i).

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