特发性高颅压中不同类型静脉窦狭窄的介入治疗  

Endovascular stenting for idiopathic intracranial hypertension with different types of venous sinus stenosis

作　　者：苏慧[1] 张荣举[1] 曹向宇[1] 刘新峰[1] 杜志华[1] 李宝民[1] 王君[1] Su Hui;Zhang Rongju;Cao Xiangyu;Liu Xinfeng;Du Zhihua;Li Baomin;Wang Jun(Department of Neurology,the First Medical Center of Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院第一医学中心神经内科,北京100853

出　　处：《中华内科杂志》2021年第8期728-733,共6页Chinese Journal of Internal Medicine

摘　　要：目的:探讨特发性高颅压(IIH)中不同类型的静脉窦狭窄以及应用脑静脉窦支架置入术后的效果。方法:回顾性分析2004年7月至2019年7月连续就诊于解放军总医院第一医学中心,99例IIH合并静脉窦狭窄,且药物治疗无效或快速进展并行静脉窦支架置入术患者的临床资料,随访时间为2.3个月至11年。结果:99例患者,其中男性21例(21.2%),女性78例(78.8%),平均年龄18~62(37±10)岁,BMI 19.2~40.6(27.0±4.4)kg/m 2。术前狭窄两端压力差为1~59(26±8)mmHg(1 mmHg=0.133 kPa),与内生型和混合型患者年龄相比,外压型患者相对较小。术后,50例(50.5%)伴随头痛,28例(28.3%)搏动性耳鸣的患者,症状完全消失,但伴有视力障碍者仅部分患者恢复。2例(2.0%)患者术后病情仍进展,数字减影血管造影(DSA)显示支架内再狭窄,其中1例行2次支架置入术,无效,随后接受了脑脊液分流手术,术后症状无进展。结论:脑静脉窦支架置入术对大部分药物难治性或快速进展性IIH合并不同类型静脉窦狭窄的患者治疗有效,少部分无效者可能需要进行脑脊液分流手术。Objective To evaluate the efficacy of endovascular stenting of various types of venous sinus stenosis in idiopathic intracranial hypertension(IIH).Method Clinical,radiological,and manometric data before and after stenting in venous sinus stenosis were retrospectively analyzed in 99 IIH patients who were refractory to medical therapy or rapidly progressed between July 2004 to July 2019.The follow-up period was between 2.3 months to 11 years.Results Our study enrolled 21 men(21.2%)and 78 women(78.8%)with average body mass index(BMI)19.2-40.6(27.0±4.4)kg/m2 and median age 37 years.Before stent placement,the mean transverse sinus stenosis gradient was 1-59(26±8)mmHg.Patients with extrinsic stenosis were younger than those with intrinsic and mixed stenosis.In all cases,stenting was effective for papilledema.Fifty patients complained of headaches.Pulsatile tinnitus in twenty-eight patients completely alleviated after stenting.In one patient,replacement of stent did not improve symptoms,and a subsequent CSF diversion procedure was performed and effective.Conclusion Irrespective of the type of stenosis,stenting of venous sinus stenosis is an effective treatment for IIH.Patients with persistent papilledema post-stenting and elevated transverse pressure pre-stenting should be followed closely as high risk of stenting failure may occur and further diversion procedure is needed.

关 键 词：颅内高压 支架 静脉窦狭窄 

分 类 号：R543.6[医药卫生—心血管疾病]