Analysis of the safety and effectiveness of mechanical thrombectomy in the treatment of cerebral venous sinus thrombosis

Abstract

Objective To analyze the effectiveness and safety of mechanical thrombectomy in the treatment of cerebral venous sinus thrombosis (CVST). Methods A retrospective review of all CVST cases treated with mechanical thrombectomy between Oct 2007 and Oct 2017 were performed. Clinical and radiological features of the patients, the effectiveness of the surgery, and the relative factors were analyzed. Results A total of 20 patients were included in this study. Main clinical symptoms and signs included headache (20 cases), vomiting (8 cases), epilepsy (6 cases), conscious disturbance (15 cases), limb asthenia (20 cases), and neck rigidity (10 cases). Glasgow coma scale core was (12.8±2.2) points before the surgery. Intracerebral hemorrhage (9 cases), cerebral ischemia (8 cases), subarachnoid hemorrhage (6 cases), cerebral hernia signs (2 cases) were found by the radiological evaluation before the surgery. Preoperative venous examination: 17 patients completed MRV and DSA both, the range of venous sinus occlusion showed by MRV was more than that by DSA in 12 cases, the sigmoid sinus was not demonstrated by MRV in 9 cases, the straight sinus was not demonstrated in 6 cases, unilateral or bilateral transverse sinus was not demonstrated in 3 cases. The range of venous sinus occlusion showed by DSA was more than that by MRV in 6 cases, including 3 cases of transverse sinus occlusion, 1 case of sigmoid sinus occlusion, 1 case of deep venous occlusion, 1 case of cerebral venous occlusion. After mechanical thrombectomy, complete or partial revascularization demonstrated by MRV or DSA was achieved in 15 cases, accounting for 75%. There were no statistically significant differences in age of onset, disease duration, main clinical symptoms, medical history, and the distribution of occluded sinus between patients with poor outcome and patients with good outcome (P>0.05). After the surgery, the whole cerebral circulation time did not significantly change in patients with poor outcome, which was significantly longer than that in patients with good outcome (P<0.05). Conclusion MRV was less sensitive in detecting deep venous and sinus occlusion. Mechanical thrombectomy was very efficient in the treatment of CVST. The high reflowing rate and short cerebral circulation time after surgery were the main determinants of good outcome. Key words: Cerebral venous sinus thrombosis; Mechanical thrombectomy; Digital subtraction angiography