Elsayed Ayman A, Moran Christopher J, Cross DeWitte T, Derdeyn Colin P, Pilgram Thomas K, Milburn James M, Dacey Ralph G, Diringer Michael N
Department of Radiology, Washington University School of Medicine, St. Louis, Missouri 63110-1076, USA.
Neurosurg Focus. 2006 Sep 15;21(3):E16. doi: 10.3171/foc.2006.21.3.16.
The goal in this study was to determine if there was a change in intracranial venous diameters after endovascular treatment of carotid distribution vasospasm caused by subarachnoid hemorrhage.
The venous diameters were measured in all patients who received intraarterial papaverine and/or balloon angioplasty for treatment of vasospasm during the study period of 3 years. To evaluate the veins of Labbe and Trolard, the straight sinus, and the superior sagittal sinus (SSS), measurements were performed in a blinded manner with the aid of a magnification loupe. Predetermined sites were evaluated on angiograms obtained before and after endovascular treatment. Forty-three treatments in 26 patients were included: 18 patients (33 territories) were treated with intraarterial papaverine alone, four (four territories) were treated with balloon angioplasty alone, and four (six territories) were treated with both papaverine infusion and angioplasty. The mean measured venous diameters increased significantly after addition of papaverine (10.9%), and also after combined papaverine and angioplasty (4.2%). There was no statistically significant increase in the mean venous diameters after angioplasty alone. If the initial intracranial pressure (ICP) was less than 15 mm Hg before treatment, the veins showed a greater tendency to dilate than if the initial ICP measurements were greater than 15 mm Hg. The straight sinus and the SSS increased more in diameter than the veins of Labbe and Trolard. There was no statistically significant correlation between the change in venous diameters with treatment and ICP.
Endovascular treatment produces measurable increases in intracranial venous diameters. However, these changes do not correlate with changes in ICP.
本研究的目的是确定蛛网膜下腔出血所致颈动脉分布区血管痉挛的血管内治疗后颅内静脉直径是否发生变化。
在3年的研究期间，对所有接受动脉内罂粟碱和/或球囊血管成形术治疗血管痉挛的患者测量静脉直径。为评估Labbe静脉、Trolard静脉、直窦和上矢状窦，在放大放大镜的辅助下以盲法进行测量。在血管内治疗前后获得的血管造影上评估预定部位。纳入26例患者的43次治疗：18例患者（33个区域）仅接受动脉内罂粟碱治疗，4例（4个区域）仅接受球囊血管成形术治疗，4例（6个区域）接受罂粟碱输注和血管成形术联合治疗。添加罂粟碱后平均测量静脉直径显著增加（10.9%），罂粟碱与血管成形术联合治疗后也增加（4.2%）。单纯血管成形术后平均静脉直径无统计学显著增加。如果治疗前初始颅内压（ICP）小于15 mmHg，静脉比初始ICP测量值大于15 mmHg时更倾向于扩张。直窦和上矢状窦直径增加比Labbe静脉和Trolard静脉更多。静脉直径变化与治疗和ICP之间无统计学显著相关性。
血管内治疗可使颅内静脉直径出现可测量的增加。然而，这些变化与ICP变化无关。
