Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida, USA.
McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA.
Pediatr Neurosurg. 2024;59(2-3):94-101. doi: 10.1159/000538184. Epub 2024 Mar 12.
Injury and subsequent thrombosis of the cerebral venous sinuses may be caused by closed head injuries secondary to a variety of different mechanisms. Skull fractures can lacerate or otherwise disrupt adjacent dural sinuses. The sequelae of such injuries may include thrombosis and either partial or total occlusion of the sinus, ultimately resulting in significant venous congestion. Sagittal sinus injury is associated with a more serious outcome due to the obligatory flow into the sinus, especially posterior to the coronal suture. In such cases, venous infarction may be a severe and life-threatening complication of head injury.
A 2-year-old female presented with a depressed skull fracture near the midline and a thrombus in the sagittal sinus. Anticoagulation, the standard treatment cerebral venous sinus thrombosis (CVST), was contraindicated due to intracranial hemorrhage, so immediate thrombectomy was performed with successful neurologic recovery at 9-month follow-up. To our knowledge, this case is the youngest patient documented to receive mechanical thrombectomy for superior sagittal sinus (SSS) thrombosis due to trauma.
Closed head injuries in pediatric patients may be associated with CVST, with resulting venous drainage compromise and profound neurologic sequelae. Unlike adult patients with spontaneous CVST in which anticoagulation are the standard of care, pediatric patients experiencing traumatic CVST may have contraindications to anticoagulants. If the patient has a contraindication to anticoagulation such as intracranial bleeding, endovascular mechanical thrombectomy may be an effective intervention when performed by an experienced neurointerventionalist.
脑静脉窦的损伤和随后的血栓形成可能由各种不同机制引起的闭合性颅脑损伤导致。颅骨骨折可撕裂或破坏邻近的硬脑膜窦。此类损伤的后果可能包括血栓形成，以及窦腔的部分或完全闭塞，最终导致显著的静脉充血。矢状窦损伤与更严重的后果相关，因为静脉必须流入窦内，尤其是在冠状缝之后。在这种情况下，静脉梗死可能是头部损伤的一种严重且危及生命的并发症。
一名 2 岁女性因中线附近的凹陷性颅骨骨折和矢状窦血栓形成就诊。由于颅内出血，抗凝治疗（脑静脉窦血栓形成 [CVST] 的标准治疗方法）被禁忌，因此立即进行机械血栓切除术，在 9 个月的随访时神经功能恢复良好。据我们所知，这是记录到的因创伤而接受机械血栓切除术治疗矢状窦（SSS）血栓形成的最年轻患者。
小儿闭合性颅脑损伤可能与 CVST 相关，导致静脉引流受损和严重的神经后遗症。与自发性 CVST 的成年患者不同，抗凝治疗是标准的治疗方法，而经历创伤性 CVST 的儿科患者可能对抗凝剂有禁忌症。如果患者存在颅内出血等抗凝禁忌症，经验丰富的神经介入医师进行血管内机械血栓切除术可能是一种有效的干预措施。
