Bhatia K, Jones N S
Department of Otorhinolaryngology-Head and Neck Surgery, Queens Medical Centre, University Hospital, Nottingham, UK.
J Laryngol Otol. 2002 Sep;116(9):667-76. doi: 10.1258/002221502760237920.
This article reviews the contemporary literature for septic cavernous sinus thrombosis (CST) with a focus on anticoagulation. Modern emphasis is placed on suspecting and treating this condition early, which is aided by recognizing clinical features attributable to sepsis, orbital venous congestion, and involvement of cranial nerves within each cavernous sinus. Established treatments include high dose broad-spectrum parenteral antibiotics, and selective surgery for concurrent suppurations. The role of anticoagulation is contentious because its efficacy is undetermined and it may cause or exacerbate concurrent intracranial haemorrhage in patients with septic CST. Moreover, prospective trials of anticoagulation may never be performed due to the rarity of this condition. Nevertheless, retrospective reviews of published reports indicate that haemorrhage caused by anticoagulation is rare, and that early adjunctive anticoagulation is beneficial in these patients if commenced after excluding the haemorrhagic sequelae of CST radiologically.
本文回顾了有关化脓性海绵窦血栓形成（CST）的当代文献，重点关注抗凝治疗。现代观点强调早期怀疑和治疗这种疾病，这有助于识别由败血症、眼眶静脉充血以及每个海绵窦内脑神经受累引起的临床特征。既定的治疗方法包括大剂量广谱胃肠外抗生素，以及针对并发脓肿的选择性手术。抗凝治疗的作用存在争议，因为其疗效尚未确定，而且它可能导致或加重化脓性CST患者并发的颅内出血。此外，由于这种疾病罕见，可能永远不会进行抗凝治疗的前瞻性试验。然而，对已发表报告的回顾表明，抗凝引起的出血很少见，并且如果在通过影像学排除CST的出血后遗症后开始早期辅助抗凝治疗，对这些患者是有益的。
