Smith T P, Higashida R T, Barnwell S L, Halbach V V, Dowd C F, Fraser K W, Teitelbaum G P, Hieshima G B
Department of Radiology, University of California, San Francisco 94143-0628.
AJNR Am J Neuroradiol. 1994 May;15(5):801-7.
To gain a preliminary understanding of the role of thrombolytic therapy for the thrombosed dural sinus, we retrospectively reviewed our initial experience.
Seven patients, ages 25 to 71, who presented with symptomatic dural sinus thrombosis and who failed a trial of medical therapy were treated with direct infusion of urokinase into the thrombosed sinus. Patients received urokinase doses ranging from 20,000 to 150,000 U/h with a mean infusion time of 163 hours (range 88 to 244 hours).
Patency of the affected dural sinus was achieved with antegrade flow in all patients. Six patients either improved neurologically over their prethrombolysis state or were healthy after thrombolysis; one of them required angioplasty. The other patient improved after surgical repair of a residual dural arteriovenous fistula. The only complications were an infected femoral access site which resolved after treatment with antibiotics and hematuria which cleared after discontinuation of anticoagulation.
Thrombolysis of the thrombosed dural sinus shows promise as a safe and efficacious treatment. The results of this study should provide the impetus for further research.
为初步了解溶栓治疗在血栓形成的硬脑膜窦中的作用，我们回顾性分析了我们的初始经验。
7例年龄在25至71岁之间、出现症状性硬脑膜窦血栓形成且药物治疗试验失败的患者，接受了将尿激酶直接注入血栓形成的窦内的治疗。患者接受的尿激酶剂量为20,000至150,000 U/小时，平均输注时间为163小时（范围88至244小时）。
所有患者受影响的硬脑膜窦均实现了顺行血流通畅。6例患者神经功能较溶栓前有所改善或溶栓后恢复健康；其中1例需要进行血管成形术。另1例患者在手术修复残留的硬脑膜动静脉瘘后病情改善。唯一的并发症是股动脉穿刺部位感染，经抗生素治疗后痊愈，以及血尿，停用抗凝治疗后血尿消失。
血栓形成的硬脑膜窦溶栓显示出作为一种安全有效的治疗方法的前景。本研究结果应为进一步研究提供动力。
