Department of Intensive Care Medicine, Royal Perth Hospital, Perth, Western Australia, Australia.
Department of Intensive Care Medicine, Fiona Stanley Hospital, University of Western Australia & Murdoch University, Perth, Western Australia, Australia.
World Neurosurg. 2024 Apr;184:e374-e383. doi: 10.1016/j.wneu.2024.01.132. Epub 2024 Jan 30.
Limited retrospective data suggest that dural venous sinus thrombosis (DVST) in traumatic brain injury (TBI) patients with skull fractures is common and associated with significant morbidity and mortality. Prospective data accurately characterizing the incidence of DVST in patients with high-risk TBI are sparse but are needed to develop evidence-based TBI management guidelines.
After obtaining institutional approval, 36 adult patients with TBI with skull fractures admitted to an Australian level III adult intensive care unit between April 2022 and January 2023 were prospectively recruited and underwent computed tomography venography or magnetic resonance venography within 72 hours of injury. When available, daily maximum intracranial pressure was recorded.
Dural venous sinus abnormality was common (36.1%, 95% confidence interval 22.5%-52.4%) and strongly associated with DVST (P = 0.003). The incidence of DVST was 13.9% (95% confidence interval 6.1%-28.7%), which was lower than incidence reported in previous retrospective studies. Of DVSTs confirmed by computed tomography venography, 80% occurred in patients with extensive skull fractures including temporal or parietal bone fractures in conjunction with occipital bone fractures (P = 0.006). However, dural venous sinus abnormality and DVST were not associated with an increase in maximum daily intracranial pressure within the first 7 days after injury.
Dural venous sinus abnormality was common in TBI patients with skull fractures requiring intensive care unit admission. DVST was confirmed in more than one third of these patients, especially patients with concomitant temporal or parietal and occipital bone fractures. Computed tomography venography is recommended for this subgroup of TBI patients.
有限的回顾性数据表明，创伤性脑损伤（TBI）伴颅骨骨折患者的硬脑膜静脉窦血栓形成（DVST）较为常见，且与较高的发病率和死亡率显著相关。目前缺乏准确描述高危 TBI 患者中 DVST 发生率的前瞻性数据，但这对于制定基于证据的 TBI 管理指南非常必要。
在获得机构批准后，我们前瞻性招募了 2022 年 4 月至 2023 年 1 月期间入住澳大利亚三级成人重症监护病房的 36 例 TBI 伴颅骨骨折的成年患者，并在损伤后 72 小时内行计算机断层静脉造影或磁共振静脉造影检查。当可行时，每日记录最大颅内压。
硬脑膜静脉窦异常较为常见（36.1%，95%置信区间 22.5%-52.4%），且与 DVST 强相关（P=0.003）。DVST 的发生率为 13.9%（95%置信区间 6.1%-28.7%），低于既往回顾性研究的报道。在经计算机断层静脉造影证实的 DVST 中，80%发生在广泛颅骨骨折患者中，包括颞骨或顶骨骨折合并枕骨骨折（P=0.006）。然而，硬脑膜静脉窦异常和 DVST 与损伤后 7 天内最大每日颅内压的增加无关。
TBI 伴颅骨骨折需入住重症监护病房的患者中，硬脑膜静脉窦异常较为常见。超过三分之一的此类患者存在 DVST，尤其是同时存在颞骨或顶骨和枕骨骨折的患者。建议对这组 TBI 患者行计算机断层静脉造影检查。
