Bracard S, Schmitt E, Klein O, Marchal J-C
Service de neuroradiologie diagnostique et thérapeutique, hôpital central, CHU de Nancy, Nancy cedex, France.
Neurochirurgie. 2008 Dec;54(6):721-3. doi: 10.1016/j.neuchi.2008.10.005. Epub 2008 Nov 11.
Neuroimaging is useful in benign intracranial hypertension (BIH), contributing to its diagnosis criteria and ruling out other causes of intracranial hypertension. CT and/or MR results may be normal or may show small ventricles, an empty sella, or more frequently optic nerve sheath dilatation. Diffusion as well as perfusion MR studies show conflicting results. Venous sinus imaging plays a growing role in BIH evaluation, because impaired cranial venous outflow is a common factor in the pathogenesis of BIH and venous sinus stenosis is frequently observed in this condition. Angiography is not the gold standard for this evaluation: angio-MR (with dynamic sequences) clearly demonstrates venous sinus stenosis (mostly located in the transverse sinus). We believe that this investigation must be carried out in every case of BIH. For medically refractory cases of BIH with associated sinus venous stenosis, sinus pressure recording may be necessary, sometimes leading to endovascular treatment of the stenosis (stenting). The results are promising, but long-term follow-up of these patients is needed.
神经影像学对良性颅内高压(BIH)的诊断很有用,有助于其诊断标准的确定并排除其他颅内高压病因。CT和/或MR结果可能正常,也可能显示脑室较小、蝶鞍空泡,或更常见的视神经鞘扩张。弥散及灌注MR研究结果相互矛盾。静脉窦成像在BIH评估中发挥着越来越重要的作用,因为颅内静脉流出受损是BIH发病机制中的一个常见因素,且在这种情况下经常观察到静脉窦狭窄。血管造影并非此项评估的金标准:血管造影MR(采用动态序列)能清晰显示静脉窦狭窄(大多位于横窦)。我们认为,对每例BIH患者均须进行此项检查。对于伴有静脉窦狭窄的药物难治性BIH病例,可能需要进行窦压力记录,有时会导致对狭窄进行血管内治疗(支架置入)。结果很有前景,但需要对这些患者进行长期随访。