Omoto Koji, Nakagawa Ichiro, Park Hun Soo, Wada Takeshi, Motoyama Yasushi, Kichikawa Kimihiko, Nakase Hiroyuki
Department of Neurosurgery, Nara Medical University, Nara, Japan.
Department of Neurosurgery, Nara Medical University, Nara, Japan.
World Neurosurg. 2019 Feb;122:203-208. doi: 10.1016/j.wneu.2018.10.189. Epub 2018 Nov 4.
Cerebral venous sinus thrombosis (CVST) is a relatively uncommon cause of stroke in pediatric patients and young adults. The clinical course of CVST is also highly variable. In particular, coma has been noted as a predictor of poor outcome. The standard treatment for CVST in adults is systemic anticoagulation, which can lead to recanalization. Endovascular mechanical thrombectomy (EMT) is considered as possibly indicated in the event of failure to respond to anticoagulation or a comatose state. However, the role of endovascular therapy in the management of pediatric and young adult CVST is unclear. Here, we describe 3 cases of successful emergent EMT for pediatric and young adult CVST presenting in a comatose state.
A 17-year-old boy presented with rapid deterioration and a comatose state despite anticoagulation using heparin. Emergent EMT was performed for CVST. Balloon percutaneous transmural angioplasty and catheter aspiration were repeatedly performed, and partial recanalization of the superior sagittal sinus was achieved by the end of the procedure. The child was discharged without neurologic deficits. Another 2 comatose cases with CVST underwent emergent EMT with balloon percutaneous transmural angioplasty and catheter aspiration, and partial recanalization was again achieved. These patients finally showed complete superior sagittal sinus recanalization and were discharged without neurologic deficits.
Pediatric and young comatose CVST warrants endovascular mechanical thrombectomy as soon as possible.
脑静脉窦血栓形成（CVST）是儿童患者和年轻成年人中相对罕见的卒中病因。CVST的临床病程也高度多变。特别是，昏迷已被视为预后不良的预测指标。成人CVST的标准治疗是全身抗凝，这可导致再通。血管内机械取栓术（EMT）被认为在对抗凝治疗无反应或处于昏迷状态时可能适用。然而，血管内治疗在儿童和年轻成人CVST管理中的作用尚不清楚。在此，我们描述3例成功对处于昏迷状态的儿童和年轻成人CVST进行紧急EMT的病例。
一名17岁男孩尽管使用肝素抗凝仍出现病情迅速恶化并昏迷。因CVST进行了紧急EMT。反复进行球囊经皮腔内血管成形术和导管抽吸，手术结束时上矢状窦部分再通。该患儿出院时无神经功能缺损。另外2例昏迷的CVST病例接受了球囊经皮腔内血管成形术和导管抽吸的紧急EMT，再次实现了部分再通。这些患者最终上矢状窦完全再通，出院时无神经功能缺损。
儿童和年轻昏迷的CVST应尽快进行血管内机械取栓术。
