Westwick Harrison J, Obaid Sami, Bordeleau-Roy Frederique, Truffer Eric, Weil Alexander G
Division of Pediatric Neurosurgery, Department of Surgery, Sainte Justine Hospital, University of Montreal, Montreal, Québec, Canada.
Department of Medicine, University of Montreal, Montreal, Québec, Canada.
Pediatr Neurosurg. 2019;54(3):212-217. doi: 10.1159/000495808. Epub 2019 Mar 20.
Surgical treatment options are limited for medically and endovascular refractory cerebral venous sinus thrombosis (CVT). We describe the technical feasibility of open, direct sinus thrombectomy in a pediatric patient with medically and endovascular refractory CVT.
A 15-year-old patient with superior sagittal sinus (SSS) thrombosis refractory to medical and endovascular treatment experienced clinical deterioration with the progression of bifrontal hematomas and cerebral edema. The patient was treated surgically with a decompressive hemicraniectomy and burr hole SSS thrombectomy with a Fogarty balloon and direct sinus injection of tissue plasminogen activator.
Surgical treatment with decompressive craniotomy and direct sinus thrombectomy was technically feasible with excellent intracranial pressure control, and radiological recanalization of the superior sagittal sinus with a good clinical outcome.
Direct surgical sinus thrombectomy is a potential concomitant treatment strategy with decompressive craniectomy for medically refractory CVT in a pediatric setting.
对于药物治疗和血管内治疗无效的脑静脉窦血栓形成（CVT），手术治疗选择有限。我们描述了在一名药物和血管内治疗均无效的小儿CVT患者中进行开放性直接窦血栓切除术的技术可行性。
一名15岁患有上矢状窦（SSS）血栓形成的患者，药物和血管内治疗均无效，随着双侧额叶血肿和脑水肿的进展，临床症状恶化。该患者接受了减压性颅骨切除术和使用Fogarty球囊进行钻孔SSS血栓切除术，并直接向窦内注射组织纤溶酶原激活剂的手术治疗。
减压开颅术和直接窦血栓切除术的手术治疗在技术上是可行的，颅内压控制良好，上矢状窦实现了放射学再通，临床结果良好。
对于小儿难治性CVT，直接手术窦血栓切除术是一种与减压颅骨切除术联合使用的潜在治疗策略。
