Keiper G L, Sherman J D, Tomsick T A, Tew J M
The Neuroscience Institute, Department of Neurosurgery, University of Cincinnati College of Medicine, and Mayfield Clinic, Ohio 45267-0515, USA.
J Neurosurg. 1999 Aug;91(2):192-7. doi: 10.3171/jns.1999.91.2.0192.
The goal of this study was to document the hazards associated with pseudotumor cerebri resulting from transverse sinus thrombosis after tumor resection. Dural sinus thrombosis is a rare and potentially serious complication of suboccipital craniotomy and translabyrinthine craniectomy. Pseudotumor cerebri may occur when venous hypertension develops secondary to outflow obstruction. Previous research indicates that occlusion of a single transverse sinus is well tolerated when the contralateral sinus remains patent.
The authors report the results in five of a total of 107 patients who underwent suboccipital craniotomy or translabyrinthine craniectomy for resection of a tumor. Postoperatively, these patients developed headache, visual obscuration, and florid papilledema as a result of increased intracranial pressure (ICP). In each patient, the transverse sinus on the treated side was thrombosed; patency of the contralateral sinus was confirmed on magnetic resonance (MR) imaging. Four patients required lumboperitoneal or ventriculoperitoneal shunts and one required medical treatment for increased ICP. All five patients regained their baseline neurological function after treatment. Techniques used to avoid thrombosis during surgery are discussed.
First, the status of the transverse and sigmoid sinuses should be documented using MR venography before patients undergo posterior fossa surgery. Second, thrombosis of a transverse or sigmoid sinus may not be tolerated even if the sinus is nondominant; vision-threatening pseudotumor cerebri may result. Third, MR venography is a reliable, noninvasive means of evaluating the venous sinuses. Fourth, if the diagnosis is made shortly after thrombosis, then direct endovascular thrombolysis with urokinase may be a therapeutic option. If the presentation is delayed, then ophthalmological complications of pseudotumor cerebri can be avoided by administration of a combination of acetazolamide, dexamethasone, lumbar puncture, and possibly lumboperitoneal shunt placement.
本研究的目的是记录肿瘤切除术后横窦血栓形成导致的假性脑瘤相关风险。硬脑膜窦血栓形成是枕下开颅术和经迷路颅骨切除术罕见且潜在严重的并发症。当静脉高压继发于流出道梗阻时可能会发生假性脑瘤。先前的研究表明，当对侧窦保持通畅时，单个横窦闭塞通常能被良好耐受。
作者报告了107例因肿瘤切除接受枕下开颅术或经迷路颅骨切除术患者中的5例结果。术后，这些患者因颅内压（ICP）升高出现头痛、视力模糊和明显的视乳头水肿。每位患者治疗侧的横窦均发生血栓形成；通过磁共振（MR）成像证实对侧窦通畅。4例患者需要行腰大池-腹腔或脑室-腹腔分流术，1例患者因ICP升高需要药物治疗。所有5例患者治疗后均恢复至基线神经功能。文中讨论了手术中用于避免血栓形成的技术。
第一，在患者接受后颅窝手术前，应使用MR静脉造影记录横窦和乙状窦的情况。第二，即使横窦或乙状窦不是优势窦，其血栓形成也可能无法被耐受；可能会导致威胁视力的假性脑瘤。第三，MR静脉造影是评估静脉窦的可靠、无创方法。第四，如果在血栓形成后不久做出诊断，那么用尿激酶进行直接血管内溶栓可能是一种治疗选择。如果出现延迟，那么通过给予乙酰唑胺、地塞米松、腰椎穿刺以及可能的腰大池-腹腔分流术可避免假性脑瘤的眼科并发症。
