静脉窦支架置入术治疗合并静脉窦狭窄的特发性颅内高压的单中心研究

doi:10.3969/j.issn.1673-5765.2019.10.004

摘要/Abstract

摘要：

目的探讨静脉窦支架置入术对合并静脉窦狭窄的特发性颅内高压（idiopathic intracranial hypertension， II H）的治疗作用。方法回顾性分析2009年7月-2019年1月在解放军总医院第一医学中心确诊并行静脉窦狭窄支架置入术的IIH患者的临床资料。术前清醒状态和术后即刻测静脉窦狭窄远近端压力差。术后1周复查腰椎穿刺测颅内压，随访术后1年临床症状改善情况。术后6～12个月行DSA检查，评估静脉窦支架置入术对合并静脉窦狭窄的IIH的治疗作用。结果共纳入97例患者，其中75例（77.3%）女性，22例（22.7%）男性，中位年龄35（15～57）岁。术前存在视力障碍74例（76.2%），头痛54例（55.7%）。97例患者行静脉窦狭窄支架置入治疗，其中93 例行单侧静脉窦狭窄支架治疗，4例行双侧静脉窦狭窄支架治疗。支架置入术中未发生并发症。支架置入术后静脉窦狭窄远近端压力差减小（18.1±7.1 vs 1.1±1.0 mm Hg，P＜0.001），腰穿检查脑脊液压力显著下降（297.0±44.8 vs 215.0±41.2 mm H2O，P =0.004）。76例患者完成了1年临床随访，其中64例视力障碍患者中56例（87.5%）明显好转，43例头痛患者中40例（93.0%）头痛减轻或消失。DSA检查随访62例，3例（4.8%）出现支架内再狭窄，2例（3.2%）出现硬脑膜动静脉瘘。结论静脉窦支架置入术是治疗合并静脉窦狭窄的IIH的一种安全、有效的治疗方式。

文章导读： 单中心回顾性研究结果显示，静脉窦支架置入术是合并静脉窦狭窄的特发性颅内高压的有效治疗方式，患者筛选和操作细节是手术效果的关键。

关键词: 特发性颅内高压; 静脉窦狭窄; 支架置入术

Abstract:

Objective To evaluate the effectiveness of venous sinus stenting on idiopathic intracranial hypertension (IIH) with cerebral venous sinus stenosis (CVSS). Methods Data of consecutive IIH patients with CVSS who underwent stenting in Department of the First Medical Center of Chinese PLA General Hospital from July 2009 to January 2019 were retrospectively collected. The trans-stenosis pressure difference was measured before operation and immediately after operation. Lumbar puncture was performed to measure intracranial pressure 1 week after operation. Clinical symptoms were followed up within 1 year and DSA imaging followup was performed at 6-12 months after operation. Results Finally, a total of 97 patients were included in this study, 75 women and 22 men, with a median age of 35.5 (15-57) years. 74 (76.2%) patients had impaired vision and 54 patients (55.7%) had headache. All patients underwent venous sinus stenting, including 93 cases with unilateral stenting and 4 cases with bilateral stenting. There were no perioperative complications. The transstenosis pressure difference significantly decreased after operation compared with that before operation (18.1±7.1 vs 1.1±1.0 mm Hg, P <0.001). The cerebrospinal fluid pressure measured by lumbar puncture also decreased significantly after operation (297.0±44.8 vs 215.0±41.2 mm H2O,P =0.004). 76 patients completed the follow-up of clinical symptoms. Of 64 cases with impaired vision, vision improved significantly or recovered completely in 56 cases (87.5%). Of 43 cases with headache, headache alleviated or disappeared in 40 cases (93.0%). 62 cases underwent DSA reexamination, in-stent restenosis occurred in 3 cases (4.8%) and dural arteriovenous fistula occurred in 2 cases (3.2%). Conclusions Venous sinus stenting is an effective and safe treatment method for idiopathic intracranial hypertension with venous sinus stenosis.

Key words: Idiopathic intracranial hypertension; Venous sinus stenosis; Stenting

侯磊, 杜志华, 曹向宇, 苏慧, 刘新峰, 张荣举, 李宝民, 王君. 静脉窦支架置入术治疗合并静脉窦狭窄的特发性颅内高压的单中心研究[J]. 中国卒中杂志, 2019, 14(10): 981-986.

HOU Lei, DU Zhi-Hua, CAO Xiang-Yu, SU Hui, LIU Xin-Feng, ZHANG Rong-Ju, LI Bao-Min, WANG Jun. Effectiveness of Venous Sinus Stenting on Idiopathic Intracranial Hypertension with Venous Sinus Stenosis: A Single Center Study[J]. Chinese Journal of Stroke, 2019, 14(10): 981-986.

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