Division of Neurology, Department of Medicine, National University Health System, 1 E Kent Ridge Road, 119228, Singapore, Singapore.
Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Clin Neuroradiol. 2020 Dec;30(4):661-670. doi: 10.1007/s00062-020-00920-3. Epub 2020 Jun 11.
Deep cerebral venous thrombosis (CVT) is an uncommon condition with a high morbidity and mortality. The optimal treatment approach for deep CVT remains uncertain and due to its low prevalence, randomized trials are not feasible. We showcase a straight sinus thrombosis treated with a large bore aspiration and performed a meta-analysis of the available literature to characterize and evaluate the various treatment modalities for patients with deep CVT.
We conducted a systematic search in PubMed, EMBASE and Ovid Medline using appropriate keywords/MESH terms search strategy. All patients with thrombosis involving the deep venous sinuses were included if treatment records were available. Outcome measures included recanalization of the affected sinus, good functional outcome assessed by a modified Rankin scale (mRS) of 0-2 or reported independent functional outcomes, permanent neurological deficits, further hemorrhage and mortality.
A total of 69 studies comprising 120 patients were included in the analysis. Anticoagulation was the most common treatment (85.8%), whilst local intrasinus thrombolysis was performed in 40.0% of the patients and mechanical endovascular modalities were employed in 20.0% of the patients. Recanalization of the occluded sinus was seen in 83.5% of the patients while 62.6% patients achieved good functional outcome. There was considerable morbidity with 60.7% having a permanent neurological deficit, 23.3% having further hemorrhage after admission and 18.6% mortality. In the cohort receiving anticoagulation, 65.3% achieved good outcome but intracranial hemorrhage at presentation was associated with poorer outcome, permanent deficits, further bleeding and mortality.
Anticoagulation is an effective treatment strategy for deep CVT; however, patients with intracranial hemorrhage at presentation often have poorer outcomes and early endovascular strategies could be considered in this subgroup.
脑深部静脉血栓形成（CVT）是一种发病率和死亡率均较高的少见病症。对于脑深部 CVT 的最佳治疗方法仍不确定，由于其发病率低，因此无法进行随机试验。我们展示了一例采用大口径抽吸治疗的直窦血栓形成病例，并对现有文献进行了荟萃分析，以描述和评估各种治疗方法对脑深部 CVT 患者的疗效。
我们使用适当的关键词/医学主题词搜索策略在 PubMed、EMBASE 和 Ovid Medline 中进行了系统搜索。如果有治疗记录，所有涉及深静脉窦血栓形成的患者均纳入研究。观察指标包括受累窦腔再通情况、改良 Rankin 量表（mRS）评分为 0-2 分或报告独立功能结局的良好功能结局、永久性神经功能缺损、进一步出血和死亡率。
共有 69 项研究（包括 120 例患者）纳入分析。抗凝治疗是最常见的治疗方法（85.8%），40.0%的患者接受了局部窦内溶栓治疗，20.0%的患者接受了机械性血管内治疗。闭塞窦腔再通率为 83.5%，62.6%的患者功能结局良好。患者发病率较高，60.7%存在永久性神经功能缺损，23.3%入院后出现进一步出血，18.6%死亡。接受抗凝治疗的患者中，65.3%的患者功能结局良好，但发病时颅内出血与较差的结局、永久性神经功能缺损、进一步出血和死亡率相关。
抗凝治疗是脑深部 CVT 的有效治疗策略；然而，发病时存在颅内出血的患者通常结局较差，可能需要考虑早期血管内治疗策略。
