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Endovascular thrombolysis for symptomatic cerebral venous thrombosis. J Neurosurg 1999 Jan;90(1):65-71

Date

07/21/1999

Pubmed ID

10413157

DOI

10.3171/jns.1999.90.1.0065

Scopus ID

2-s2.0-0032900624 (requires institutional sign-in at Scopus site)   101 Citations

Abstract

OBJECT: The authors sought to treat potentially catastrophic intracranial dural and deep cerebral venous thrombosis by using a multimodality endovascular approach.

METHODS: Six patients aged 14 to 75 years presented with progressive symptoms of thrombotic intracranial venous occlusion. Five presented with neurological deficits, and one patient had a progressive and intractable headache. All six had known risk factors for venous thrombosis: inflammatory bowel disease (two patients), nephrotic syndrome (one), cancer (one), use of oral contraceptive pills (one), and puerperium (one). Four had combined dural and deep venous thrombosis, whereas clot formation was limited to the dural venous sinuses in two patients. All patients underwent diagnostic cerebral arteriograms followed by transvenous catheterization and selective sinus and deep venous microcatheterization. Urokinase was delivered at the proximal aspect of the thrombus in dosages of 200,000 to 1,000,000 IU. In two patients with thrombus refractory to pharmacological thrombolytic treatment, mechanical wire microsnare maceration of the thrombus resulted in sinus patency. Radiological studies obtained 24 hours after thrombolysis reconfirmed sinus/vein patency in all patients. All patients' symptoms and neurological deficits improved, and no procedural complications ensued. Follow-up periods ranged from 12 to 35 months, and all six patients remain free of any symptomatic venous reocclusion. Factors including patients' age, preexisting medical conditions, and duration of symptoms had no statistical bearing on the outcome.

CONCLUSIONS: Patients with both dural and deep cerebral venous thrombosis often have a variable clinical course and an unpredictable neurological outcome. With recent improvements in interventional techniques, endovascular therapy is warranted in symptomatic patients early in the disease course, prior to morbid and potentially fatal neurological deterioration.

Author List

Philips MF, Bagley LJ, Sinson GP, Raps EC, Galetta SL, Zager EL, Hurst RW

Author

Grant P. Sinson MD Associate Professor in the Neurosurgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Aged
Catheterization, Peripheral
Cerebral Angiography
Cerebral Veins
Contraceptives, Oral
Female
Follow-Up Studies
Humans
Inflammatory Bowel Diseases
Injections, Intralesional
Intracranial Embolism and Thrombosis
Male
Melanoma
Micromanipulation
Middle Aged
Nephrotic Syndrome
Plasminogen Activators
Puerperal Disorders
Risk Factors
Sinus Thrombosis, Intracranial
Thrombolytic Therapy
Treatment Outcome
Urokinase-Type Plasminogen Activator
Vascular Patency
Venous Thrombosis