特发性颅内高压患者行静脉窦支架成形术后视乳头水肿及视力改善情况分析  

Evaluation of papilledema and visual improvement in patients with idiopathic intracranial hypertension after venous sinus stenting

作　　者：王伟 贾强[2] 范一木[2] 李旭东[2] 王世波[2] 程磊 王红光[2] 梁伟伦[2] 边领斋 佟小光[2] Wang Wei;Jia Qiang;Fan Yimu;Li Xudong;Wang Shibo;Cheng Lei;Wang Hongguang;Liang Weilun;Bian Lingzhai;Tong Xiaoguang(Graduate School of Tianjin Medical University,Tianjin 300070,China;Department of Neurosurgery,Tianjin Huanhu Hospital,Tianjin 300350,China)

机构地区：[1]天津医科大学研究生院,300070 [2]天津市环湖医院神经外科,300350

出　　处：《中华外科杂志》2021年第12期1012-1017,共6页Chinese Journal of Surgery

基　　金：天津市科技重大专项与工程(18ZXDBSY00180)。

摘　　要：目的探讨特发性颅内高压患者行静脉窦支架成形术后视乳头水肿及视力的改善情况。方法回顾性分析2016年1月至2020年5月于天津市环湖医院神经外科接受静脉窦支架成形术治疗的8例特发性颅内高压患者的临床资料。女性6例,男性2例,年龄(32.9±14.4)岁(范围:19~57岁)。手术前后行眼底、视力、视野检查,使用相干光层析成像术(OCT)检测患者视网膜神经纤维层(RNFL)厚度,并行腰椎穿刺测量颅内压。术中先行静脉窦测压,若狭窄两端压力梯度≥10 mmHg(1 mmHg=0.133 kPa),则接受静脉窦支架成形术治疗。术后6个月检测RNFL厚度,并行CT静脉造影观察静脉窦情况。手术前后数据比较采用配对样本t检验或Wilcoxon符号秩检验。结果8例患者均成功行静脉窦支架成形术,术后狭窄两端压力梯度降至(2.6±2.0)mmHg,与术前(24±9.2)mmHg相比,差异有统计学意义(t=8.02,P<0.001)。颅内压由术前的(41.4±12.7)cmH_(2)O(1 cmH_(2)O=0.098 kPa)降至术后的(12.9±3.3)cmH_(2)O(t=7.08,P<0.01)。术后6个月随访时,RNFL厚度由术前的(275.3±68.3)μm降至(131.4±31.8)μm(t=5.80,P=0.001);视力基线值中位数由术前的[M(QR)]0.24(0.25)改善至0.65(0.23)(Z=-2.52,P=0.012)。6例患者视乳头水肿情况明显改善,2例无明显变化,其中1例CT静脉造影提示支架旁再狭窄。结论静脉窦支架成形术可用于改善特发性颅内高压患者的视乳头水肿和视力损伤。Objective To evaluate the improvement of papilledema and visual acuities in patients with idiopathic intracranial hypertension(IIH)after venous sinus stenting.Methods The clinical data of 8 IIH patients who met the inclusion criteria underwent venous sinus stenting between January 2013 and December 2016 at Department of Neurosurgery,Tianjin Huanhu Hospital were analyzed retrospectively.There were 6 females and 3 males,aged(32.9±14.4)years(range:19 to 57 years).The thickness of the retinal nerve fiber layer(RNFL)was measured by optical coherence tomography.Fundus,visual acuity and visual field examination were performed before and after operation.If pressure gradient≥10 mmHg(1 mmHg=0.133 kPa)across the venous stenosis was indicated by intraoperative pressure measurement,the patient would be treated with venous sinus stenting.Intracranial pressure was measured by lumbar puncture 3 to 7 days after operation.RNFL thickness and eye examination were detected 6 months after surgery.CT venogram was used to observe the sinus venous conditions.Paired t test was used to compare the data before and after surgery.Results All the 8 patients underwent venous sinus stenting successfully.The mean pressure gradient across the venous stenosis was reduced from(24±9.2)mmHg to(2.6±2.0)mmHg(t=8.02,P<0.01).Intracranial pressure decreased from preoperative(41.4±12.7)cmH_(2)O(1 cmH_(2)O=0.098 kPa)to postoperative(12.9±3.3)cmH_(2)O(t=7.08,P<0.01).The RNFL thickness decreased from(275.3±68.3)μm to(131.4±31.8)μm(t=5.80,P<0.05)6 months after surgery and the baseline visual acuity was improved from(M(QR))0.24(0.25)to 0.65(0.23)(Z=-2.52,P<0.05).Papilledema was significantly improved in 6 patients,and no significant change in 2 patients.CT venogram indicated adjacent stent restenosis in 1 patient.Conclusion Venous sinus stenting can effectively improve papilledema and visual acuity caused by IIH.

关 键 词：颅内高压 支架 静脉窦狭窄 相干光层析成像术 视网膜神经纤维层 

分 类 号：R651.12[医药卫生—外科学]