Cipri S, Gangemi A, Campolo C, Cafarelli F, Gambardella G
Division of Neurosurgery, Bianchi-Morelli-Melacrino Hospital, Reggio Calabria, Italy.
J Neurosurg Sci. 1998 Mar;42(1):23-32.
The management of intracranial dural sinuses thrombosis is still controversial and uncertain. The authors report the cases of 7 patients with non-traumatic thrombosis of the dural sinuses and describe the most important radiographic findings, the indication, effectiveness of antithrombotic therapy, and outcome.
A retrospective review was conducted of 7 cases of dural sinus thrombosis admitted, between 1994 and 1996, to our division. All patients underwent full anticoagulation therapy. Heparin was administered, using a dose of 25,000 units/day for two weeks; warfarin was given using a dose of 5 mg twice daily. Treatment course was followed by maintenance treatment with a single administration of 5 mg/day of warfarin. All patients were submitted to close titration and coagulation profile monitoring.
In 4 cases Magnetic Resonance Imaging-Angiography (Angio-MRI) was performed for following up the recanalization of the sinuses, resulting a persistent no patency of the dural sinuses. Three patients underwent contrast-enhanced CT scan, demonstrated an "empty delta sign" in the sagittal sinus, confirming no recanalization. Nevertheless, six patients had have a good quality recovery, and one patient a moderate disability.
Cerebral venous sinus thrombosis is an uncommon cause of cerebral infarction, and may be mistaken, unless specifically sought. The natural history of the disease is highly variable, with a mortality rates range from 10% to 20%. At present, in our opinion, the venous phase of Angio-MRI is the definitive examination, and a gold standard for diagnosis of dural sinus thrombosis. In our cases, antithrombotic therapy has been found to be a safe and effective treatment, despite contrast-CT scans and Angio-MRI showed no recanalization of the sinuses, in all patients.
颅内硬脑膜窦血栓形成的治疗仍存在争议且尚无定论。作者报告了7例非创伤性硬脑膜窦血栓形成患者的病例，并描述了最重要的影像学表现、抗血栓治疗的指征、有效性及结果。
对1994年至1996年间收入我科的7例硬脑膜窦血栓形成病例进行回顾性研究。所有患者均接受了充分的抗凝治疗。给予肝素，剂量为25000单位/天，持续两周；给予华法林，剂量为5毫克，每日两次。治疗过程后采用每日单次给予5毫克华法林进行维持治疗。所有患者均接受密切滴定和凝血指标监测。
4例患者进行了磁共振血管造影（Angio-MRI）以随访窦道再通情况，结果显示硬脑膜窦持续未通畅。3例患者接受了增强CT扫描，显示矢状窦有“空三角征”，证实未再通。然而，6例患者恢复良好，1例患者有中度残疾。
脑静脉窦血栓形成是脑梗死的罕见原因，除非专门检查，否则可能会被误诊。该病的自然病程差异很大，死亡率在10%至20%之间。目前，我们认为，Angio-MRI的静脉期是确定性检查，是诊断硬脑膜窦血栓形成的金标准。在我们的病例中，尽管对比CT扫描和Angio-MRI显示所有患者的窦道均未再通，但抗血栓治疗已被证明是一种安全有效的治疗方法。
