Strategies in the treatment for intracranial venous sinus thrombosis

Abstract

Background Cerebral venous sinus thrombosis (CVST) is a special type of cerebrovascular disease with high morbidity and mortality which often has an unpredictable outcome. It is usually misdiagnosed because of different causes and variable clinical manifestations. How to improve the diagnosis and therapy of CVST is always the hotspot in clinic. This article aims to investigate the effective and safe strategies in the treatment for CVST. Methods Clinical data of 52 patients diagnosed with CVST were retrospectively analyzed. These patients were subdivided into mild type and severe type according to the features of symptoms, signs, lumbar puncture pressure and imaging. The patients with mild type were treated with systemic anticoagulant therapy combined with intravenous thrombolysis [continuous intravenous infusion of heparin (12.50-25) × 10 3 U/d for 7-10 d followed by a continuous infusion of urokinase (0.50-0.75) × 106 U/d for 5-7 d]. The patients with severe type were treated with endovascular thrombolysis [injection of urokinase (0.50-1) × 10 6 U, 0.10 × 10 6 U/min via carotid or vertebral artery; or intravenous infusion of urokinase 1 × 106 U/d and heparin 25 × 103 U/d for 5-7 d], and superior sagittal sinus cut-open/intrasinus thrombolysis separately. All the patients took oral warfarin for 6-12 months, and follow-up was performed after operation by the method of magnetic resonance venography (MRV). Results Among the 27 cases of mild type receiving systemic anticoagulant agents and intravenous thrombolysis, 14 were cured; 9 were improved; 4 were ineffective. Among the 22 cases of severe type receiving systemic anticoagulant drugs and endovascular thrombolysis, 18 were cured; 3 were improved; 1 was dead. The left 3 cases with gravis type received superior sagittal sinus cut⁃open/intrasinus thrombolysis and were cured. The period of follow-up was between 6 months and 60 months (the median time was 36 months), and no recurrence happened. Conclusion It was probable to subdivide CVST into mild type and severe type according to the features of symptoms, signs, lumbar puncture pressure and imaging. Different therapeutic strategies were proved to be safe and effective in the treatment of different types.