Chang Tao, Yang Yan-Long, Gao Li, Li Li-Hong
Department of Emergency Medicine, Second Affiliated Hospital of Air Force Medical University, Xi'an 710038, Shaanxi Province, China.
Department of Neurosurgery, Second Affiliated Hospital of Air Force Medical University, Xi'an 710038, Shaanxi Province, China.
World J Clin Cases. 2020 Mar 26;8(6):1158-1163. doi: 10.12998/wjcc.v8.i6.1158.
Cerebral venous sinus thrombosis (CVST) is a rare condition in patients with craniopharyngioma following transsphenoidal surgery.
A 56-year-old man who underwent transsphenoidal surgery for craniopharyngioma 26 d ago presented gradual headache and cerebrospinal fluid leakage while vomiting 5 d post-discharge and required readmission to our department of neurosurgery. After admission, head imaging examination showed a hyperdense shadow in the superior sagittal sinus and right transverse sinus, edema at the bilateral parietal lobe, and hemorrhage at the left parietal lobe and right occipital lobe; the venous phase of cerebral angiography revealed CVST. The patient was treated immediately by intravenous thrombolysis, endovascular thrombolysis, and mechanical thrombectomy after the definite diagnosis. However, the neurological status of the patient continued to deteriorate and he died on the fourth day after readmission.
For craniopharyngioma undergoing transsphenoidal surgery, it is vital to take an effective strategy to manage the postoperative complications, such as diabetes insipidus, severe electrolyte imbalance, and cerebrospinal fluid leakage. Additionally, the early differential diagnosis of CVST is essential when it develops clinical symptoms, especially in patients following transsphenoidal surgery with a high risk of CVST. Subsequently, the timely and effective treatment of the CVST is critical for preventing neurological deterioration.
脑静脉窦血栓形成（CVST）在经蝶窦手术后的颅咽管瘤患者中是一种罕见情况。
一名56岁男性在26天前接受了经蝶窦颅咽管瘤手术，出院5天后出现逐渐加重的头痛、脑脊液漏伴呕吐，需要再次入住我们神经外科。入院后，头颅影像学检查显示上矢状窦和右侧横窦高密度影，双侧顶叶水肿，左侧顶叶和右侧枕叶出血；脑血管造影静脉期显示CVST。确诊后立即对患者进行静脉溶栓、血管内溶栓和机械取栓治疗。然而，患者神经功能状态持续恶化，再次入院后第4天死亡。
对于接受经蝶窦手术的颅咽管瘤患者，采取有效策略处理术后并发症，如尿崩症、严重电解质紊乱和脑脊液漏至关重要。此外，当CVST出现临床症状时，早期鉴别诊断至关重要，尤其是在经蝶窦手术后发生CVST风险较高的患者中。随后，及时有效地治疗CVST对于预防神经功能恶化至关重要。
