Calgary Pediatric Stroke Program, Calgary, Alberta, Canada.
Pediatrics. 2011 Aug;128(2):e429-35. doi: 10.1542/peds.2010-3896. Epub 2011 Jul 11.
Neonatal cerebral sinovenous thrombosis (CSVT) causes lifelong morbidity. Newborns frequently incur positional occipital bone compression of the superior sagittal sinus (SSS). We hypothesized that SSS compression is associated with neonatal CSVT.
Our retrospective case-control study recruited neonates with CSVT (SickKids Children's Stroke Program, January 1992-December 2006). Controls were neonates without CSVT undergoing magnetic resonance or computed tomography venography (institutional imaging database, 2002-2005) who were matched 2 per each case patient. Blinded neuroimaging review by 2 experts quantified SSS compression and head position. Effect of SSS compression on the primary outcome of CSVT was determined (logistic regression). Secondary analyses included the relationship of head position to SSS compression (t test) and group comparisons (cases versus controls, cases with and without compression) for demographic, clinical, and CSVT factors (χ² and Wilcoxon Mann-Whitney tests).
Case (n = 55) and control (n = 90) patients had similar ages and delivery modes. SSS compression was common (cases: 43%; controls: 41%). Controlling for gender and head position, SSS compression was associated with CSVT (odds ratio: 2.5 [95% confidence interval: 1.07-5.67]). Compression was associated with greater mean (SD) angle toward head flexion (101.2 [15.0] vs 111.5 [9.7]; P < .001). Among CSVT cases, neonates with and without compression had comparable gestational age, delivery mode, risk factors, anticoagulation treatment, thrombus location, propagation, infarction, recanalization, and outcome. Many idiopathic cases had SSS compression (79%). Interrater reliability of compression measurements was high (κ = 0.87).
Neonatal SSS compression is common, quantifiable, and associated with CSVT. Optimizing head position and/or developing devices to alleviate mechanical SSS compression may represent a novel means to improve outcomes.
新生儿脑静脉窦血栓形成（CSVT）可导致终生发病。新生儿经常会出现枕骨后位导致上矢状窦（SSS）受压。我们假设 SSS 受压与新生儿 CSVT 有关。
我们的回顾性病例对照研究纳入了 1992 年 1 月至 2006 年 12 月期间患有 CSVT 的新生儿（ SickKids 儿童中风计划）。对照组为在 2002 年至 2005 年期间接受磁共振或计算机断层静脉造影的无 CSVT 新生儿（机构成像数据库），每个病例患者匹配 2 例。由 2 名专家进行的盲法神经影像学检查评估了 SSS 受压和头部位置。确定 SSS 受压对 CSVT 主要结局的影响（逻辑回归）。次要分析包括头位与 SSS 受压的关系（t 检验）以及组间比较（病例组与对照组、有受压与无受压的病例组），比较的因素包括人口统计学、临床和 CSVT 因素（χ² 和 Wilcoxon 曼-惠特尼检验）。
病例组（n=55）和对照组（n=90）患者的年龄和分娩方式相似。SSS 受压很常见（病例组：43%；对照组：41%）。控制性别和头位后，SSS 受压与 CSVT 相关（优势比：2.5[95%置信区间：1.07-5.67]）。受压与头前屈角度的平均值（标准差）增大有关（101.2[15.0]比 111.5[9.7]；P<0.001）。在 CSVT 病例中，有受压与无受压的新生儿在胎龄、分娩方式、危险因素、抗凝治疗、血栓位置、传播、梗死、再通和结局方面无差异。许多特发性病例存在 SSS 受压（79%）。两位评估者的 SSS 受压测量的一致性很高（κ=0.87）。
新生儿 SSS 受压很常见，可量化，且与 CSVT 有关。优化头位和/或开发减轻 SSS 机械性受压的设备可能是改善结局的新方法。
