Bai Yang, Dong Liansheng, Yu Chunyong, Feng Sizhe, Liang Guobiao
Department of Neurosurgery, General Hospital of Northern Theater Command, Shenyang, China.
Department of Neurosurgery, Ansteel General Hospital, Anshan, China.
Front Oncol. 2022 Nov 1;12:977038. doi: 10.3389/fonc.2022.977038. eCollection 2022.
As a rare type of cerebral venous thrombosis, isolated cortical vein thrombosis (ICVT) is easily misdiagnosed as brain tumor, especially in the cases with prominent signs of parenchymal brain lesions. Despite controversy concerning the efficacy and safety, anticoagulant treatment dominates in current therapeutic strategies for ICVT. As yet, surgical thrombectomy in the treatment of ICVT has not been reported. We present hereafter a female with ICVT previously misdiagnosed as brain tumor who had successful surgical thrombectomy.
A 54-year-old female with progressive left-sided limb weakness suddenly developed focal tonic-clonic epileptic seizure. Physical examination indicated strength of 0/5 in the left limbs. Magnetic resonance imaging (MRI) showed an irregular juxtacortical lesion surrounded with massive edema in the frontoparietal cortex, which was initially diagnosed as glioma. However, it turned out to be ICVT of the central sulcus vein during craniotomy. Then, venotomy and thrombectomy were performed, with instant recanalization of the vein noticed during surgery. In retrospect, we identified the suspected ICVT of the central sulcus vein in preoperative magnetic resonance venotography (MRV) and contrast MRI images. Laboratory tests also revealed homocysteinemia and hypercoagulable states in the patient. Follow-up MRV obtained 3 months after discharge showed cortical vein recanalization. At the one-year follow-up, she exhibited subtle sequelae of weakness in the left lower limb with a modified Rankin scale score of 1.
Physicians should be aware of ICVT in the differential diagnoses in patients with risk factors, classical symptoms, and parenchymal brain lesions in or near cortex. Surgical thrombectomy excels at realizing definite recanalization and avoiding systematic complications of anticoagulation. It might be a therapeutic alternative for ICVT, especially when craniotomy is performed for treating intracranial hypertension or a definite diagnosis is made during craniotomy.
作为一种罕见的脑静脉血栓形成类型，孤立性皮质静脉血栓形成（ICVT）很容易被误诊为脑肿瘤，尤其是在具有明显脑实质病变体征的病例中。尽管在疗效和安全性方面存在争议，但抗凝治疗在目前ICVT的治疗策略中占主导地位。迄今为止，尚未有关于ICVT手术取栓治疗的报道。我们在此介绍一位曾被误诊为脑肿瘤的ICVT女性患者，其接受手术取栓治疗成功。
一名54岁女性，左侧肢体进行性无力，突然出现局灶性强直阵挛性癫痫发作。体格检查显示左侧肢体肌力为0/5。磁共振成像（MRI）显示额顶叶皮质有一个不规则的皮质下病变，周围有大量水肿，最初被诊断为胶质瘤。然而，在开颅手术中发现是中央沟静脉的ICVT。然后进行了静脉切开和取栓术，术中注意到静脉立即再通。回顾性分析，我们在术前磁共振静脉造影（MRV）和对比增强MRI图像中发现了中央沟静脉疑似ICVT。实验室检查还显示患者存在高同型半胱氨酸血症和高凝状态。出院后3个月的随访MRV显示皮质静脉再通。在1年的随访中，她表现出左下肢轻度无力的后遗症，改良Rankin量表评分为1分。
医生在对有危险因素、典型症状以及皮质内或皮质附近脑实质病变的患者进行鉴别诊断时应意识到ICVT。手术取栓在实现明确再通和避免抗凝的系统性并发症方面表现出色。它可能是ICVT的一种治疗选择，尤其是在为治疗颅内高压而进行开颅手术或在开颅手术中做出明确诊断时。
