Soltanolkotabi Maryam, Rahimi Shahram, Hurley Michael C, Bowman Robin M, Russell Eric J, Ansari Sameer A, Shaibani Ali
Departments of Radiology and.
J Neurosurg Pediatr. 2013 Dec;12(6):660-3. doi: 10.3171/2013.9.PEDS12232. Epub 2013 Oct 18.
The authors report on the case of a 7-year-old boy who presented with a reduced level of activity, macrocephaly, prominent scalp veins, and decreased left-sided visual acuity. Imaging workup demonstrated generalized cerebral volume loss, bilateral chronic subdural hematomas, absent left sigmoid sinus, hypoplastic left transverse sinus, and severe focal weblike stenosis of the right sigmoid sinus. Right sigmoid sinus angioplasty and stent insertion was performed, with an immediate reduction in the transduced intracranial venous pressure gradient across the stenosis (from 22 to 3 mm Hg). Postprocedural diminution of prominent scalp and forehead veins and spinal venous collateral vessels was followed by a progressive improvement in visual acuity and physical activity over a 1-year follow-up period, supporting the efficacy of angioplasty and stent insertion in intracranial venous outflow obstruction. There are multiple potential causes of intracranial venous hypertension in children. Development of dural sinus stenosis in infancy may be one such cause, mimicking the clinical presentation of other causes such as vein of Galen malformations. This condition can be ameliorated by early endovascular revascularization.
作者报告了一名7岁男孩的病例，该男孩表现为活动水平降低、巨头畸形、头皮静脉突出和左侧视力下降。影像学检查显示全脑体积减小、双侧慢性硬膜下血肿、左侧乙状窦缺如、左侧横窦发育不全以及右侧乙状窦严重局灶性网状狭窄。对右侧乙状窦进行了血管成形术和支架置入术，狭窄处经转导的颅内静脉压力梯度立即降低（从22毫米汞柱降至3毫米汞柱）。术后突出的头皮和前额静脉以及脊髓静脉侧支血管减少，随后在1年的随访期内视力和身体活动逐渐改善，这支持了血管成形术和支架置入术治疗颅内静脉流出道梗阻的有效性。儿童颅内静脉高压有多种潜在原因。婴儿期硬脑膜窦狭窄的发生可能是其中一个原因，其临床表现与其他原因如大脑大静脉畸形相似。这种情况可通过早期血管内血运重建得到改善。
