Matsuda Yoshikazu, Owai Yoshihiro, Kakishita Koji, Nakao Naoyuki
Department of Neurosurgery, Hashimoto Municipal Hospital, Hashimoto, Wakayama, Japan.
Wakayama Medical University School of Medicine Graduate School of Medicine, Department of Neurological Surgery, Wakayama, Japan.
BMJ Case Rep. 2018 Apr 26;2018:bcr-2017-013730. doi: 10.1136/bcr-2017-013730.
Cerebral venous sinus thrombosis is sometimes fatal. We describe a case of sinus thrombosis in a 43-year-old woman presenting with generalized seizure, delirium, and a 2 week history of headache and nausea. The patient underwent mechanical thrombectomy using a novel combined approach, in which a Shouryu HR balloon catheter (Kaneka) was anchored in the right transverse sinus (TS), sigmoid sinus (SS), and superior sagittal sinus (SSS), while a Penumbra 5 MAX ACE (Penumbra) catheter was moved back and forth between the right TS, SS, and SSS. Additionally, back and forth movement of the inflated balloon with aspiration-the so-called 'dental floss technique'-was performed. Partial recanalization was eventually obtained. Follow-up angiography on postoperative day 7 showed a dramatic improvement in venous outflow. The patient was transferred to a rehabilitation hospital on postoperative day 42. We describe our combined approach using aspiration, and Penumbra and balloon catheters, to achieve mechanical thrombectomy for sinus thrombosis.
大脑静脉窦血栓形成有时是致命的。我们描述了一例43岁女性的窦血栓形成病例，该患者出现全身性癫痫发作、谵妄，并有2周的头痛和恶心病史。患者采用一种新型联合方法进行了机械取栓术，其中将Shouryu HR球囊导管（Kaneka公司）固定在右侧横窦（TS）、乙状窦（SS）和上矢状窦（SSS），同时Penumbra 5 MAX ACE（Penumbra公司）导管在右侧TS、SS和SSS之间来回移动。此外，还进行了充气球囊的来回移动并抽吸——即所谓的“牙线技术”。最终实现了部分再通。术后第7天的随访血管造影显示静脉流出有显著改善。患者在术后第42天被转至康复医院。我们描述了我们使用抽吸、Penumbra和球囊导管的联合方法来实现窦血栓形成的机械取栓术。
