Huang Deborah L, Bhatia Ritwik, Simmasalam Rubinee, Talbott Jason F, Huang Michael C, Singh Vineeta
Department of Neurology, University of California San Francisco, San Francisco, CA, USA.
Department of Radiology, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA.
Neurocrit Care. 2025 May 22. doi: 10.1007/s12028-025-02278-1.
Traumatic brain injury can lead to venous sinus injury and thrombosis, which may be associated with elevated intracranial pressure and poor outcomes. We sought to examine the risk factors, management, and clinical outcomes of traumatic venous sinus thrombosis (tVST).
We conducted a comprehensive search of our institutional radiology database for final radiology reports from 2013 to 2022 that contained the terms "venous sinus thrombosis," "sinus thrombosis," or "venous occlusion." tVST was detected on computed tomography and confirmed by a board-certified neuroradiologist.
We identified 135 patients on initial screening and entered 112 into our final analysis. Patients were predominantly male (76.8%) and had a mean age of 44 years. Initial Glasgow Coma Scale scores of 13-15, 9-12, and 3-8 were found in 60.7%, 12.5%, and 26.8% of our cohort, respectively. Eighty-nine patients (79.5%) were alive at hospital discharge. Most patients sustained skull fractures (n = 109, 97.3%), including skull base fractures. Seventeen patients required interventions for refractory intracranial hypertension, of whom 16 (94.1%) had multiple tVST. We observed heterogeneity in tVST monitoring and treatment practices. Patients received anticoagulation (AC; 13.4%), antiplatelet (AP; 34.8%), or conservative (no AC or AP; 51.8%) treatment for tVST. Follow-up imaging was available for 52 patients, showing recanalization of venous sinuses in 26 patients (50%) by 6 months post injury. Recanalization rates were higher in the AP group than in the AC group. However, this was likely the result of selection bias, in which patients with mild to moderate injuries were more likely to be assigned to AP therapy. We noted more bleeding complications in AC- and AP-treated patients (20.0% and 12.8%) than in conservatively managed patients (3.4%), even after adjusting for lower survival in the conservative group.
Differences between treatment groups should be cautiously interpreted due to selection bias and confounding by indication. More studies are needed to determine the optimal management of tVST.
创伤性脑损伤可导致静脉窦损伤和血栓形成，这可能与颅内压升高及不良预后相关。我们旨在研究创伤性静脉窦血栓形成（tVST）的危险因素、治疗方法及临床结局。
我们对本机构的放射学数据库进行了全面检索，查找2013年至2022年包含“静脉窦血栓形成”“窦血栓形成”或“静脉闭塞”等术语的最终放射学报告。通过计算机断层扫描检测到tVST，并由一名获得委员会认证的神经放射科医生进行确认。
初步筛查时我们确定了135例患者，最终纳入分析的有112例。患者以男性为主（76.8%），平均年龄44岁。在我们的队列中，初始格拉斯哥昏迷量表评分为13 - 15分、9 - 12分和3 - 8分的患者分别占60.7%、12.5%和26.8%。89例患者（79.5%）出院时存活。大多数患者发生颅骨骨折（n = 109，97.3%），包括颅底骨折。17例患者因难治性颅内高压需要干预，其中16例（94.1%）有多处tVST。我们观察到tVST监测和治疗方法存在异质性。患者接受抗凝治疗（AC；13.4%）、抗血小板治疗（AP；34.8%）或保守治疗（不进行AC或AP；51.8%）。52例患者有随访影像学检查结果，显示26例患者（50%）在受伤后6个月时静脉窦再通。AP组的再通率高于AC组。然而，这可能是选择偏倚的结果，即轻度至中度损伤的患者更有可能被分配接受AP治疗。我们注意到，即使对保守治疗组较低的生存率进行调整后，接受AC和AP治疗的患者的出血并发症（分别为20.0%和12.8%）仍多于保守治疗的患者（3.4%）。
由于选择偏倚和指征性混杂因素，应谨慎解读治疗组之间的差异。需要更多研究来确定tVST的最佳治疗方法。
