Hagioka Tatsuya, Shimizu Takeshi, Toyota Shingo, Murakami Tomoaki, Achiha Takamune, Takahara Motohide, Touhara Kazuhiro, Hoshikuma Yuhei, Kobayashi Maki, Kishima Haruhiko
Department of Neurosurgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan.
Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
NMC Case Rep J. 2023 Sep 29;10:241-245. doi: 10.2176/jns-nmc.2023-0076. eCollection 2023.
A 54-year-old man with no medical history presented to our hospital with vomiting, left hemiplegia, and seizures. On arrival, he was experiencing generalized tonic-clonic seizures, which required him to be intubated and deeply sedated. Contrast-enhanced computed tomography revealed extensive venous sinus obstruction from the superior sagittal sinus to the bilateral sigmoid sinus and cerebral edema with intracranial hemorrhage. An intracranial pressure (ICP) monitor was immediately placed intracranially, and mechanical thrombectomy (MT) was performed under ICP monitoring. MT was immediately terminated when the venous sinus was partially recanalized enough to decrease the ICP; then, anticoagulation therapy was initiated. Postoperative follow-up angiography revealed that venous sinus obstruction and intracranial venous perfusion improved over time. Although he had intracranial hemorrhage-induced left hemiplegia and sensory deficits, his condition improved with rehabilitation, and the patient was eventually discharged home. The indication criteria and techniques for MT for cerebral venous sinus thrombosis are yet to be established. As in this case, in patients with impaired consciousness due to intracranial hemorrhage or epilepsy, preoperative ICP monitor placement is deemed useful to evaluate venous perfusion during MT and decide the treatment goal.
一名无病史的54岁男性因呕吐、左侧偏瘫和癫痫发作前来我院就诊。入院时，他正在经历全身性强直阵挛性癫痫发作，这需要对他进行插管并深度镇静。增强计算机断层扫描显示，从上矢状窦到双侧乙状窦存在广泛的静脉窦阻塞，伴有脑水肿和颅内出血。立即在颅内放置颅内压（ICP）监测器，并在ICP监测下进行机械取栓术（MT）。当静脉窦部分再通足以降低ICP时，MT立即终止；然后开始抗凝治疗。术后随访血管造影显示，静脉窦阻塞和颅内静脉灌注随时间改善。尽管他因颅内出血导致左侧偏瘫和感觉障碍，但通过康复治疗他的病情有所改善，患者最终出院回家。脑静脉窦血栓形成的MT适应证标准和技术尚未确立。就像这个病例一样，对于因颅内出血或癫痫导致意识障碍的患者，术前放置ICP监测器被认为有助于评估MT期间的静脉灌注并确定治疗目标。
