Frank Garett S, Smith Jesse M, Davies Brett W, Mirsky David M, Hink Eric M, Durairaj Vikram D
Oculoplastic and Orbital Surgery, Department of Ophthalmology, University of Colorado Hospital, Aurora.
Oculoplastic and Orbital Surgery, Department of Ophthalmology, University of Colorado Hospital, Aurora; Oculoplastic and Orbital Surgery, Department of Ophthalmology, San Antonio; Military Medical Center/Wilford Hall, San Antonio, Texas.
J AAPOS. 2015 Aug;19(4):358-62. doi: 10.1016/j.jaapos.2015.06.001. Epub 2015 Jul 31.
To review the causes, treatment, and outcomes of cavernous sinus thrombosis (CST) in children.
The medical records of children (<18 years of age) diagnosed with thrombophlebitis of an intracranial venous sinus were reviewed to identify cases of CST presenting to Children's Hospital Colorado from January 2000 through January 2013. Cases were evaluated for etiology, symptoms, imaging characteristics, treatment, and outcomes.
A total of 110 children with a venous thrombus of an intracranial sinus were included. Of these, 9 had a CST. All cases were confirmed by magnetic resonance imaging. All 9 had sinusitis, 4 had orbital involvement, and 1 resulted from a nasal septal abscess. Eight cases presented with ophthalmoplegia, and 5 presented with decreased vision. Every patient underwent sinus surgery: 4 underwent orbitotomy for abscess drainage, and 1 required bilateral exenteration. Cultures were inconclusive in 2 cases, and 2 cases were culture positive rhino-orbital mucormycosis. There was 1 case of methicillin-resistant Staphylococcus aureus. Of the 9 cases, 4 returned to normal vision and ocular motility; 5 had permanent ophthalmoplegia and vision loss. There were no cases of mortality.
CST is a rare complication of orbital and sinus disease. High clinical suspicion, early neurologic imaging, and a multidisciplinary approach to management are key factors in reducing morbidity and mortality from CST in children.
回顾儿童海绵窦血栓形成（CST）的病因、治疗及预后。
回顾诊断为颅内静脉窦血栓性静脉炎的儿童（<18岁）病历，以确定2000年1月至2013年1月在科罗拉多州儿童医院就诊的CST病例。对病例进行病因、症状、影像学特征、治疗及预后评估。
共纳入110例颅内静脉窦血栓患儿，其中9例为CST。所有病例均经磁共振成像确诊。9例均有鼻窦炎，4例累及眼眶，1例由鼻中隔脓肿引起。8例出现眼肌麻痹，5例视力下降。所有患者均接受了鼻窦手术：4例行眶切开术引流脓肿，1例需要双侧眼眶内容剜除术。2例培养结果不明确，2例培养为阳性的鼻眶毛霉菌病。有1例耐甲氧西林金黄色葡萄球菌感染。9例中，4例视力和眼球运动恢复正常；5例有永久性眼肌麻痹和视力丧失。无死亡病例。
CST是眼眶和鼻窦疾病的罕见并发症。高度的临床怀疑、早期神经影像学检查以及多学科管理方法是降低儿童CST发病率和死亡率的关键因素。
