Gabay Segev, Dunetz Guy, Bergman Lottem, Niry Dana, Roth Jonathan
Department of Neurosurgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
University at Buffalo, State University of New York, Buffalo, United States.
Neuroradiology. 2025 Jun 23. doi: 10.1007/s00234-025-03670-6.
Cerebral venous sinus thrombosis (CVST) can increase intracranial pressure and cause secondary brain injury. There is uncertainty in the literature regarding the risk of traumatic CVST (tCVST) following fractures over a major sinus, the need and timing for venous imaging, and treatment. The current study aims to review our experience with tCVST when treating patients with isolated linear fractures over the major sinuses. Methods. This is a retrospective study of 95 adult patients, treated between January 2017 and March 2023, with mild, blunt, isolated traumatic head injury (GCS 13-15) and cranial fracture traversing the major dural venous sinus. Data regarding presentation, radiological features, hospitalization, and follow-up course of CVST were collected and analyzed. Images suspected to show a CVST were retrospectively reviewed by two teams blinded to the radiological interpretation. Results. Of 95 patients, 31 (32%) were identified as having or suspected to have CVST as interpreted by the radiologists. Among them, 14 were treated with anticoagulation, and 1 was treated with anti-aggregate for concomitant arterial dissection. There were no long-term symptoms or newly diagnosed CVST amongst the entire cohort. No major morbidity or mortality occurred. Upon analyzing the images retrospectively, the inter-rater reliability varied. The agreement was fair for definite cases of CVST, slight for uncertain cases that showed epidural hematoma compression and narrowing of the sinus, or arachnoid granulations, and almost perfect for patients without thrombosis. Conclusions. Amongst patients with mild, isolated, blunt traumatic head injury, with fractures traversing major dural venous sinus, true CVST may be over-diagnosed, with some of the lesions being local epidural hematomas mimicking CVST. The outcome of CVST was excellent, whether or not they were treated with anti-thrombotic medications.
脑静脉窦血栓形成（CVST）可升高颅内压并导致继发性脑损伤。关于主要静脉窦骨折后创伤性CVST（tCVST）的风险、静脉成像的必要性和时机以及治疗，文献中存在不确定性。本研究旨在回顾我们在治疗主要静脉窦孤立线性骨折患者时tCVST的经验。方法。这是一项对95例成年患者的回顾性研究，这些患者在2017年1月至2023年3月期间接受治疗，患有轻度、钝性、孤立性创伤性头部损伤（格拉斯哥昏迷评分13 - 15分）且颅骨骨折穿过主要硬脑膜静脉窦。收集并分析有关CVST的临床表现、放射学特征、住院情况和随访过程的数据。由两个对放射学解释不知情的团队对疑似显示CVST的图像进行回顾性审查。结果。在95例患者中，放射科医生解读为有或疑似有CVST的患者有31例（32%）。其中，14例接受了抗凝治疗，1例因合并动脉夹层接受了抗聚集治疗。整个队列中没有长期症状或新诊断的CVST。未发生重大并发症或死亡。回顾性分析图像时，评估者间的可靠性各不相同。对于明确的CVST病例，一致性为中等；对于显示硬膜外血肿压迫和静脉窦狭窄或蛛网膜颗粒的不确定病例，一致性为轻微；对于无血栓形成的患者，一致性几乎为完美。结论。在患有轻度、孤立性、钝性创伤性头部损伤且骨折穿过主要硬脑膜静脉窦的患者中，真正的CVST可能被过度诊断，一些病变是模拟CVST的局部硬膜外血肿。无论是否接受抗血栓药物治疗，CVST的预后都很好。
