Stefini R, Latronico N, Cornali C, Rasulo F, Bollati A
Department of Neurosurgery, University of Brescia, Spedali Civili, Italy.
Neurosurgery. 1999 Sep;45(3):626-9; discussion 629-30. doi: 10.1097/00006123-199909000-00038.
Cerebral venous and dural sinus thrombosis is a rare cause of stroke. Although morbidity and mortality have greatly decreased in recent years as a result of early diagnosis and timely medical treatment, when coma occurs the prognosis remains poor. We evaluated whether emergent decompressive craniectomy has a role in the treatment of patients with brain herniation from dural sinus thrombosis and hemorrhagic infarct.
Three patients developed large hemorrhagic infarct with coma and bilaterally fixed and dilated pupils resulting from aseptic dural sinus thrombosis.
Two patients underwent emergent surgical decompression as soon as brain herniation developed, and these patients had complete functional recovery. One underwent delayed surgical decompression and remained severely disabled.
Our results provide preliminary evidence that emergent decompressive craniectomy is effective in patients with brain herniation from dural sinus thrombosis, provided that the clinical onset is recent. We therefore recommend consideration of this aggressive surgical technique for such patients, who may survive with good outcomes.
脑静脉和硬脑膜窦血栓形成是卒中的一种罕见病因。尽管近年来由于早期诊断和及时治疗，发病率和死亡率已大幅下降，但出现昏迷时预后仍然很差。我们评估了急诊减压性颅骨切除术在治疗因硬脑膜窦血栓形成和出血性梗死导致脑疝的患者中是否起作用。
3例患者因无菌性硬脑膜窦血栓形成出现大面积出血性梗死，伴有昏迷及双侧瞳孔固定散大。
2例患者一旦出现脑疝就立即接受了急诊手术减压，这些患者功能完全恢复。1例患者接受了延迟手术减压，仍严重致残。
我们的结果提供了初步证据，表明急诊减压性颅骨切除术对因硬脑膜窦血栓形成导致脑疝的患者有效，前提是临床发病时间较近。因此，我们建议对此类患者考虑采用这种积极的手术技术，这些患者可能会获得良好的生存结局。
