经颈静脉入路支架成形术治疗特发性颅高压综合征合并静脉窦狭窄的疗效  

Efficacy of patients with idiopathic intracranial hypertension syndrome complicated with venous sinus stenosis treated with stent angioplasty via jugular vein approach

作　　者：莫大鹏[1] 罗岗[1] 王伊龙[2] 刘恋[1] 宋立刚[1] 董可辉[2] 缪中荣[1] 

机构地区：[1]首都医科大学附属北京天坛医院介入神经病学科,100050 [2]首都医科大学附属北京天坛医院神经内科,100050

出　　处：《中华神经外科杂志》2016年第5期486-490,共5页Chinese Journal of Neurosurgery

摘　　要：目的探讨经颈静脉入路支架成形术治疗特发性颅高压（IIH）综合征合并静脉窦狭窄（CVSS）的安全性和有效性。方法回顾性分析2013年7月至2015年9月首都医科大学附属北京天坛医院介入神经病学科采用经颈静脉入路支架成形术治疗的IIH合并CVSS的患者，共27例。观察临床疗效。结果治疗前27例患者狭窄两端的压力差为14～32mmHg（1mmHg=0．133kPa），平均（18±14）mmHg。支架成功置入26例，术后静脉窦狭窄消失，狭窄两端压力差降至0～1mmHg。1例失败，改行球囊扩张术，但术后狭窄改善不明显。所有患者术中和术后均未发生与手术相关的并发症。27例患者平均随访9．5个月（3～19个月）。无症状19例，症状改善7例。支架术后1个月余患者视盘水肿均明显缓解。除4例术后视力改善不明显外，其余视力均在术后1个月改善。术后3个月16例行CT静脉造影，6个月10例行DSA检查，均显示支架通畅，无再狭窄发生。结论经颈静脉入路支架成形术治疗IIH合并CVSS的患者，可能是一种安全、有效的治疗方法。Objective To investigate the safety and effectiveness of patients with idiopathic intraeranial hypertension （IIH） syndrome complicated with cerebral venous sinus stenosis （CVSS） treated with stent angioplasty via jugular vein approach. Methods Twenty-seven patients with IIH complicated with CVSS treated with stent angioplasty via jugular vein approach at the Department of Interventional Neurology, Beijing Tiantan Hospital, Capital Medical University from July 2013 to September 2015 were analyzed retrospectively. Their clinical efficacy was observed. Results The pressure differences at both ends of the stenosis were 14 - 32 mmHg （mean 18 ±14 mmHg） in 27 cases before treatment. The stents were successfully implanted in 26 cases. The venous sinus stenosis disappeared after procedure. The pressure difference at both ends of the stenosis was reduced to 0 - 1 mmHg. The treatment failed in 1 case and he was treated with balloon dilatation, but postoperative stenosis was not improved significantly. No intraoperative and postoperative complications associated with surgery occurred in this group. Twenty-seven patients were followed up for a mean of 9.5 months （3 - 19 months）, 19 did not have any symptoms, and the symptoms of 7 cases were improved. More than a month after stenting, the papilledema of the patients was obviously improved. In addition to the improvement of postoperative visual acuity not obvious in 4 cases, others were improved at 1 month after procedure. Three months after procedure, 16 cases underwent CT venography. After 6 months, 10 patients were examined with DSA. They all showed that the stents were patent and no restenosis occurred. Conclusion Stent angioplasty via jugular approach for the treatment of patients with IIH complicated with CVSS may be a safe and effective method.

关 键 词：假脑瘤 颅窦 缩窄 病理性 血管成形术 

分 类 号：R651.1[医药卫生—外科学]