Background

Deep cerebral venous thrombosis (CVT) is an uncommon condition with a high morbidity and mortality. The optimal treatment approach for deep CVT remains uncertain and due to its low prevalence, randomized trials are not feasible. We showcase a straight sinus thrombosis treated with a large bore aspiration and performed a meta-analysis of the available literature to characterize and evaluate the various treatment modalities for patients with deep CVT.

Methods

We conducted a systematic search in PubMed, EMBASE and Ovid Medline using appropriate keywords/MESH terms search strategy. All patients with thrombosis involving the deep venous sinuses were included if treatment records were available. Outcome measures included recanalization of the affected sinus, good functional outcome assessed by a modified Rankin scale (mRS) of 0–2 or reported independent functional outcomes, permanent neurological deficits, further hemorrhage and mortality.

Results

A total of 69 studies comprising 120 patients were included in the analysis. Anticoagulation was the most common treatment (85.8%), whilst local intrasinus thrombolysis was performed in 40.0% of the patients and mechanical endovascular modalities were employed in 20.0% of the patients. Recanalization of the occluded sinus was seen in 83.5% of the patients while 62.6% patients achieved good functional outcome. There was considerable morbidity with 60.7% having a permanent neurological deficit, 23.3% having further hemorrhage after admission and 18.6% mortality. In the cohort receiving anticoagulation, 65.3% achieved good outcome but intracranial hemorrhage at presentation was associated with poorer outcome, permanent deficits, further bleeding and mortality.

Conclusion

Anticoagulation is an effective treatment strategy for deep CVT; however, patients with intracranial hemorrhage at presentation often have poorer outcomes and early endovascular strategies could be considered in this subgroup.

中文翻译：

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深部脑静脉血栓形成治疗：使用抽吸和审查各种治疗方式的血管内病例。

背景

深部脑静脉血栓形成（CVT）是一种罕见的疾病，发病率和死亡率都很高。深部 CVT 的最佳治疗方法仍不确定，由于其患病率低，随机试验不可行。我们展示了用大口径抽吸治疗的直窦血栓形成，并对现有文献进行了荟萃分析，以表征和评估深部 CVT 患者的各种治疗方式。

方法

我们使用适当的关键字/MESH 术语搜索策略在 PubMed、EMBASE 和 Ovid Medline 中进行了系统搜索。如果有治疗记录，所有涉及深静脉窦血栓形成的患者都包括在内。结果指标包括受影响窦的再通、通过 0-2 的改良 Rankin 量表 (mRS) 评估的良好功能结果或报告的独立功能结果、永久性神经功能缺损、进一步出血和死亡率。

结果

分析中总共包括 69 项研究，包括 120 名患者。抗凝是最常见的治疗方法（85.8%），40.0% 的患者进行了局部窦内溶栓，20.0% 的患者采用了机械血管内治疗。83.5% 的患者发现闭塞的鼻窦再通，而 62.6% 的患者获得了良好的功能结果。有相当大的发病率，60.7% 有永久性神经功能缺损，23.3% 有入院后进一步出血和 18.6% 死亡率。在接受抗凝治疗的队列中，65.3% 的患者获得了良好的结果，但就诊时颅内出血与较差的结果、永久性缺陷、进一步出血和死亡率相关。

结论

抗凝是深部 CVT 的有效治疗策略；然而，就诊时有颅内出血的患者通常预后较差，在该亚组中可以考虑早期血管内治疗。