Hagihara Ryota, Matsuda Ken, Yomo Munetaka, Hirose Satoshi, Arishima Hidetaka, Kikuta Kenichiro
Department of Neurosurgery, Sugita Genpaku Memorial Obama Municipal Hospital, Obama, Fukui, Japan.
Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Yoshida-gun, Fukui, Japan.
J Neuroendovasc Ther. 2025;19(1). doi: 10.5797/jnet.cr.2024-0119. Epub 2025 Mar 15.
To assess the efficacy of mechanical thrombectomy (MT) for cerebral venous sinus thrombosis associated with Ewing sarcoma invasion into the venous sinus.
A 48-year-old woman presented to our hospital with left hemifacial paralysis. The patient had undergone surgical treatment for left subclavian Ewing sarcoma 24 years ago. Furthermore, the patient had undergone tumor resection for very late metastasis in the left occipital bone and mastoid air cells 3 years prior to her admission. As the Ewing sarcoma had extended to the left transverse sinus, the sinus was resected during craniotomy. The tumor remained in the mastoid air cells, and radiotherapy was administered. On admission to our hospital, FLAIR revealed hyper-intensities in the straight sinus and the superior sagittal sinus. Magnetic resonance venography revealed no signal in the posterior part of the superior sagittal sinus and the bilateral transverse sinuses. The patient was diagnosed with cerebral venous sinus thrombosis, and anticoagulation therapy was administered. However, the swelling and pain on the left side of the face worsened, and intraocular pressure (IOP) increased. Therefore, an MT was performed. After endovascular treatment, the patient's facial swelling and pain were reduced, and IOP returned to normal. Pathological examination of the captured thrombus revealed tumor cells, suggesting venous sinus invasion of Ewing sarcoma.
Although it was a palliative treatment, MT was effective in confirming the diagnosis of tumor invasion into the venous sinus and improving the patient's quality of life.
评估机械取栓术（MT）治疗尤因肉瘤侵犯静脉窦所致脑静脉窦血栓形成的疗效。
一名48岁女性因左侧面瘫入院。该患者24年前曾接受左锁骨下尤因肉瘤的手术治疗。此外，患者入院前3年因左枕骨和乳突气房的晚期转移接受了肿瘤切除术。由于尤因肉瘤已蔓延至左侧横窦，开颅手术期间切除了该静脉窦。肿瘤残留于乳突气房，并进行了放射治疗。入院时，液体衰减反转恢复序列（FLAIR）显示上矢状窦和直窦高信号。磁共振静脉血管造影显示上矢状窦后部及双侧横窦无信号。患者被诊断为脑静脉窦血栓形成，并接受了抗凝治疗。然而，患者左侧面部肿胀和疼痛加重，眼压升高。因此，进行了机械取栓术。血管内治疗后，患者面部肿胀和疼痛减轻，眼压恢复正常。对取出的血栓进行病理检查发现肿瘤细胞，提示尤因肉瘤侵犯静脉窦。
尽管这是一种姑息性治疗，但机械取栓术在确诊肿瘤侵犯静脉窦及改善患者生活质量方面是有效的。
