Shroff Manohar, deVeber Gabrielle
Department of Diagnostic Imaging, Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON M5G 1X8, Canada.
Neuroimaging Clin N Am. 2003 Feb;13(1):115-38. doi: 10.1016/s1052-5149(02)00064-3.
Sinus thrombosis in children is increasingly recognized; however, the diagnosis is still frequently missed. Children may have an increased incidence of this disorder compared with adults, and neonates are at greatly increased risk compared with older children. Childhood CSVT carries significant long-term sequelae that include death or neurologic deficits in nearly 50% of cases. Neonates are not spared from these sequelae. At present, the approach to treatment is empiric but in the past decade treatment with anti-coagulants is supported by the unacceptable rates of adverse outcomes, the pathophysiology of CSVT, and the data supporting the efficacy and safety of anti-coagulation for adult CSVT. Among the most significant current and future developments in childhood CSVT is the evolution of accurate, noninvasive and economical neuroimaging techniques. The latter techniques have the potential to increase the detection rate of childhood CSVT, improve our understanding of the pathophysiology and define important subgroups of patients who best respond to treatment. An international interest in childhood CSVT is developing and, in the next decade, will enable the necessary multi-national clinical trials to provide evidence-based treatments and decrease the adverse outcomes.
儿童鼻窦血栓形成越来越受到关注；然而，诊断仍常常被漏诊。与成人相比，儿童患这种疾病的发病率可能更高，与大龄儿童相比，新生儿的患病风险大幅增加。儿童慢性鼻窦炎伴发静脉血栓形成（CSVT）会带来严重的长期后遗症，近50%的病例会出现死亡或神经功能缺损。新生儿也不能幸免这些后遗症。目前，治疗方法是经验性的，但在过去十年中，抗凝治疗得到了支持，因为不良后果的发生率令人无法接受，CSVT的病理生理学，以及支持成人CSVT抗凝疗效和安全性的数据。儿童CSVT当前和未来最重要的发展之一是准确、无创且经济的神经成像技术的演进。后一种技术有可能提高儿童CSVT的检出率，增进我们对病理生理学的理解，并确定对治疗反应最佳的重要患者亚组。国际上对儿童CSVT的关注度正在提高，在未来十年，将开展必要的多国临床试验，以提供循证治疗并减少不良后果。
