Shlobin Nathan A, LoPresti Melissa A, Beestrum Molly, Lam Sandi
Department of Neurological Surgery, Division of Pediatric Neurosurgery, Anne and Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, 225 E Chicago Ave, Box 28, Chicago, IL, 60611, USA.
Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA.
Childs Nerv Syst. 2020 Nov;36(11):2621-2633. doi: 10.1007/s00381-020-04829-7. Epub 2020 Aug 2.
Cerebral venous sinus thromboses (CVST) occur in children with a variety of etiologies. However, no standard treatment paradigm is established. We sought to identify what treatments have been applied, their outcomes, and the role of anticoagulation in pediatric patients with CVST.
A systematic review was conducted exploring all treatments of pediatric CVSTs using PubMed, Embase, Scopus, and Cochrane Library and Cochrane Central Register of Controlled Trials. Studies meeting inclusion criteria were reviewed in full and analyzed for study design, aim, population, interventions, and outcomes.
Of 2946 resultant articles, 51 full-text articles were included. Management of infectious CVST included broad-spectrum antibiotics, surgery, and anticoagulation. Neoplastic and traumatic CVST treatment included anticoagulation. Treatment of CVSTs associated with metabolic abnormalities centered on correction of metabolic derangements, or supplementation where appropriate, and anticoagulation. Autoimmune, congenital, and thrombotic pathway CVSTs were treated with anticoagulation and treatment of the underlying disorder. Unfractionated heparin and low molecular weight heparin were most commonly used and seen to be effective and safe. Uncommonly, endovascular interventions including venous thrombectomy and intravenous injection of thrombolytic therapy were used with varying success.
While conservative, medical, thombolytic, endovascular, and surgical treatment all have a role in in the treatment of pediatric CVSTs, anticoagulation is commonly applied and found to be safe and effective in pediatrics. Risks and benefits of anticoagulation must be considered on an individual basis as no randomized trials have established a standard of care. Based on our findings, we propose an approach to CVST treatment and look to future study aimed at more clearly delineating treatment dose, duration, and timing of re-evaluation in these patients.
儿童脑静脉窦血栓形成（CVST）有多种病因。然而，尚未建立标准的治疗模式。我们试图确定已应用了哪些治疗方法、其疗效以及抗凝在儿童CVST患者中的作用。
通过PubMed、Embase、Scopus以及Cochrane图书馆和Cochrane对照试验中央注册库，对儿童CVST的所有治疗方法进行了系统评价。对符合纳入标准的研究进行全文审查，并分析其研究设计、目的、人群、干预措施和结果。
在检索到的2946篇文章中，纳入了51篇全文文章。感染性CVST的治疗包括广谱抗生素、手术和抗凝。肿瘤性和创伤性CVST的治疗包括抗凝。与代谢异常相关的CVST治疗以纠正代谢紊乱或适当补充以及抗凝为中心。自身免疫性、先天性和血栓形成途径的CVST采用抗凝治疗并治疗潜在疾病。普通肝素和低分子肝素是最常用的，且被认为有效且安全。罕见情况下，会使用包括静脉血栓切除术和静脉注射溶栓治疗在内的血管内干预措施，成功率各不相同。
虽然保守治疗、药物治疗、溶栓治疗、血管内治疗和手术治疗在儿童CVST的治疗中都有作用，但抗凝治疗是常用的，且在儿科中被发现是安全有效的。由于尚无随机试验确立护理标准，因此必须根据个体情况考虑抗凝的风险和益处。基于我们的研究结果，我们提出了一种CVST治疗方法，并期待未来的研究能够更清楚地界定这些患者的治疗剂量、持续时间和重新评估的时机。
