Mascitelli Justin R, Pain Margaret, Zarzour Hekmat K, Baxter Peter, Ghatan Saadi, Mocco J
Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Department of Otorhinolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
BMJ Case Rep. 2015 May 22;2015:bcr2015011782. doi: 10.1136/bcr-2015-011782.
Intracranial complications of sinusitis are rare but life threatening. We present a case of a 17-year-old woman with sinusitis who deteriorated over the course of 12 days from subdural empyema and global purulent cerebral venous sinus thrombosis. The patient was managed with surgery and mechanical thrombectomy utilizing a novel 'stent anchor with mobile aspiration technique', in which a Trevo stent retriever (Stryker) was anchored in the superior sagittal sinus (SSS) while a 5 MAX ACE reperfusion catheter (Penumbra) was passed back and forth from the SSS to the sigmoid sinus with resultant dramatic improvement in venous outflow. The patient was extubated on postoperative day 3 and was discharged with minimal lower extremity weakness on postoperative day 11. This is the first report using the Trevo stent retriever for sinus thrombosis. It is important to keep these rare complications in mind when evaluating patients with oral and facial infections.
鼻窦炎的颅内并发症虽罕见但危及生命。我们报告一例17岁鼻窦炎女性患者,其在12天内病情恶化,出现了硬膜下积脓和全脓性脑静脉窦血栓形成。该患者接受了手术及采用新型“带移动抽吸技术的支架锚定法”进行的机械取栓治疗,即将Trevo支架取栓器(史赛克公司)锚定在上矢状窦,同时将5 MAX ACE再灌注导管(Penumbra公司)从上矢状窦至乙状窦来回移动,从而使静脉流出显著改善。患者术后第3天拔管,术后第11天出院,下肢仅有轻微无力。这是首例使用Trevo支架取栓器治疗窦血栓形成的报告。在评估口腔和面部感染患者时,牢记这些罕见并发症很重要。