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[颅内硬脑膜静脉窦血栓形成及解剖变异]

[Thrombosis and anatomic variants of intracranial dural venous sinuses].

作者信息

Maksimova M Yu, Dubovitskaya Yu I

机构信息

Research Center of Neurology, Moscow, Russia.

出版信息

Zh Nevrol Psikhiatr Im S S Korsakova. 2021;121(3. Vyp. 2):5-9. doi: 10.17116/jnevro20211210325.

DOI:10.17116/jnevro20211210325
PMID:33908225
Abstract

A rather large number of different anatomic variants of intracranial dural venous sinuses are known, and they are found so often that interpreting them only as anomalies is unlikely, except for variations such as sinus aplasia or doubling, which can be attributed to anomalies of the venous system. Diameter reduction (hypoplasia) of the transverse and sigmoid sinuses is observed relatively often. In cases of dural sinuses anomalies, sinuses on the contralateral side are necessarily evaluated as the main source of compensation. When diagnosing dural sinus thrombosis, it is necessary to have a clear idea of the structure of the cerebral venous system, so as not to mistakenly accept hypoplasia or sinus aplasia for thrombosis. Our own experience is based on the results of a neuroimaging study of cerebral veins and venous sinuses in 103 patients (average age 35±10 years) with a tension-type headache. Hypoplasia of the transverse and sigmoid sinuses was detected in 21 (22.4%) cases. In 10 cases (6 men, 4 women), a connection was established between hypoplasia of the dural sinuses and thrombosis. Four patients, presented with hypoplasia of the right transverse and sigmoid sinuses and 6 patients with hypoplasia of the left transverse and sigmoid sinuses. Thrombosis developed on the side of sinus hypoplasia (9 patients) or on the contralateral side (1 patient). Early diagnosis of cerebral venous thrombosis is crucial because the use of anticoagulants reduces the risk of a poor prognosis, severe disability without an additional increase in the risk of brain hematomas progression.

摘要

颅内硬脑膜静脉窦存在相当多不同的解剖变异,而且它们很常见,以至于除了诸如窦发育不全或重复等可归因于静脉系统异常的变异外,仅将它们解释为异常情况是不太可能的。横窦和乙状窦直径减小(发育不全)的情况相对较为常见。在硬脑膜窦异常的病例中,对侧的窦必然被视为主要的代偿来源。在诊断硬脑膜窦血栓形成时,有必要清楚了解脑静脉系统的结构,以免将发育不全或窦发育不全误认作血栓形成。我们自己的经验基于对103例紧张型头痛患者(平均年龄35±10岁)的脑静脉和静脉窦进行神经影像学研究的结果。在21例(22.4%)病例中检测到横窦和乙状窦发育不全。在10例(6名男性,4名女性)病例中,硬脑膜窦发育不全与血栓形成之间建立了联系。4例患者右侧横窦和乙状窦发育不全,6例患者左侧横窦和乙状窦发育不全。血栓形成发生在窦发育不全侧(9例患者)或对侧(1例患者)。脑静脉血栓形成的早期诊断至关重要,因为使用抗凝剂可降低预后不良、严重残疾的风险,而不会额外增加脑血肿进展的风险。

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