脑静脉窦支架置入术治疗特发性颅内压增高的临床分析  

Clinical analysis of cerebral venous sinus stenting for the treatment of idiopathic intracranial hypertension

作　　者：桂月江 GUI Yue-jiang(Neurology Department,Ordos Central Hospital,Ordos 017000,China)

机构地区：[1]鄂尔多斯市中心医院神经内科,017000

出　　处：《中国实用医药》2023年第23期85-88,共4页China Practical Medicine

摘　　要：目的 探讨脑静脉窦支架置入术治疗特发性颅内压增高(IIH)的临床疗效。方法 回顾性分析4例IIH患者的临床资料、诊治经过及随访结果 ,并结合文献学习,了解脑静脉窦支架置入术治疗IIH的有效性及安全性。结果 4例患者虽均诊断为IIH伴颅内静脉窦狭窄,但临床核心症状有区别,其中病例1临床症状最为严重,出现此病相关的所有临床症状,包括头痛、恶心、呕吐、视力下降/视物重影及搏动性耳鸣。病例2的核心症状为视物模糊,病例3、4的核心症状为搏动性耳鸣。4例患者术前腰椎穿刺脑脊液压力均大于正常,其中病例1最高。术中测得的静脉窦狭窄前后压力梯度均>8 mm Hg(1 mm Hg=0.133 kPa),静脉窦支架置入术后压力阶梯均明显降低。术后4例患者的临床症状均明显好转,病例1视物重影症状在手术治疗后约14 h恢复正常,视力约术后2个月左右完全恢复正常;病例2视物模糊症状约术后1个月恢复正常;病例1、3、4搏动性耳鸣症状术后立即消失。病例3、4患者焦虑、抑郁状态术后也逐渐好转。术中及术后随访未发现手术相关并发症。结论 在血流动力学功能学评估的指导下,脑静脉窦支架置入术通过打开狭窄的静脉窦,消除静脉窦狭窄的压力阶梯,打破颅内压增高及静脉窦狭窄之间的恶性循环,对治疗IIH是安全且有效的。Objective To explore the clinical efficacy and safety of venous sinus stenting in the treatment of idiopathic intracranial hypertension(IIH).Methods The clinical data,diagnosis and treatment process and follow-up results of 4 patients with IIH were retrospectively analyzed,and the effectiveness and safety of cerebral venous sinus stenting in the treatment of IIH were studied in combination with literature study.Results Although all four patients were diagnosed as IIH WITH intracranial venous sinus stenosis,the clinical core symptoms were different,of which case 1 had the most serious clinical symptoms,and almost had all the clinical symptoms related to the disease,including headache,nausea,vomiting,decreased vision accuracy,visual loss,and pulsatile tinnitus.The core symptom of case 2 wass blurred vision,while the core symptom of case 3 and 4 were pulsatile tinnitus.The cerebrospinal fluid pressure of lumbar puncture was higher than normal in all 4 patients before interventional therapy,and the highest in case 1.Trans-stenosis pressure gradient>8 mm Hg(1 mm Hg=0.133 kPa),and the pressure gradient was significantly reduced after venous sinus stenting.The clinical symptoms of all 4 patients resolved gradually after stenting.In case 1,diplopia was completely relieved within 14 h after stenting,and the visual acuity completely returned to normal about 2 months after stenting.In case 2,blurred visual recovered approximately 1 month after treatment;the symptoms of pulsatile tinnitus in case 1 and case 3 disappeared immediately after stenting.In case 3 and case 4,anxiety and depression gradually improved after treatment.No stenting related complications were found intraoperation and postoperative follow-up.Conclusion Venous sinus stenting based on the hemodynamic assessment is safe and effective for the treatment of IIH by opening the narrow venous sinus,eliminating the pressure gradient of venous sinus stenosis,and breaking the vicious cycle between increased intracranial pressure and venous sinus stenosis.

关 键 词：特发性颅内压增高 静脉窦支架置入 静脉窦狭窄 血流动力学评估 压力阶梯 

分 类 号：R741[医药卫生—神经病学与精神病学]