Background

Cerebral venous sinus thromboses (CVST) occur in children with a variety of etiologies. However, no standard treatment paradigm is established. We sought to identify what treatments have been applied, their outcomes, and the role of anticoagulation in pediatric patients with CVST.

Methods

A systematic review was conducted exploring all treatments of pediatric CVSTs using PubMed, Embase, Scopus, and Cochrane Library and Cochrane Central Register of Controlled Trials. Studies meeting inclusion criteria were reviewed in full and analyzed for study design, aim, population, interventions, and outcomes.

Results

Of 2946 resultant articles, 51 full-text articles were included. Management of infectious CVST included broad-spectrum antibiotics, surgery, and anticoagulation. Neoplastic and traumatic CVST treatment included anticoagulation. Treatment of CVSTs associated with metabolic abnormalities centered on correction of metabolic derangements, or supplementation where appropriate, and anticoagulation. Autoimmune, congenital, and thrombotic pathway CVSTs were treated with anticoagulation and treatment of the underlying disorder. Unfractionated heparin and low molecular weight heparin were most commonly used and seen to be effective and safe. Uncommonly, endovascular interventions including venous thrombectomy and intravenous injection of thrombolytic therapy were used with varying success.

Conclusions

While conservative, medical, thombolytic, endovascular, and surgical treatment all have a role in in the treatment of pediatric CVSTs, anticoagulation is commonly applied and found to be safe and effective in pediatrics. Risks and benefits of anticoagulation must be considered on an individual basis as no randomized trials have established a standard of care. Based on our findings, we propose an approach to CVST treatment and look to future study aimed at more clearly delineating treatment dose, duration, and timing of re-evaluation in these patients.

中文翻译：

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小儿脑静脉窦血栓形成的治疗：抗凝作用。

背景

脑静脉窦血栓形成（CVST）发生在具有多种病因的儿童中。但是，没有建立标准的治疗范例。我们试图确定已采用的治疗方法，其结果以及抗凝在小儿CVST患者中的作用。

方法

进行了系统的综述，探讨了使用PubMed，Embase，Scopus和Cochrane图书馆以及Cochrane中央对照试验注册簿对儿科CVST的所有治疗方法。对符合入选标准的研究进行全面审查，并分析研究设计，目标，人群，干预措施和结果。

结果

在2946篇结果文章中，包括51篇全文文章。传染性CVST的管理包括广谱抗生素，手术和抗凝治疗。肿瘤和创伤性CVST治疗包括抗凝治疗。与代谢异常相关的CVST的治疗集中在纠正代谢紊乱或适当补充和抗凝方面。自身免疫，先天性和血栓形成途径的CVSTs经过抗凝治疗和潜在疾病的治疗。最常用的是普通肝素和低分子量肝素，它们被认为是安全有效的。罕见地，包括静脉血栓切除术和静脉内溶栓治疗的血管内介入治疗获得了不同程度的成功。

结论

尽管保守，医学，溶栓，血管内和外科治疗均在儿科CVST的治疗中起作用，但抗凝治疗是普遍应用的，并且在儿科中是安全有效的。由于尚无随机试验建立护理标准，因此必须单独考虑抗凝治疗的风险和益处。根据我们的发现，我们提出了一种CVST治疗方法，并期待着将来的研究，目的是更清楚地描述这些患者的治疗剂量，持续时间和重新评估的时机。