Direct Endovascular Thrombolytic Therapy for Dural Sinus Thrombosis

Neurosurgery ◽  
1991 ◽  
Vol 28 (1) ◽  
pp. 135-142 ◽  
Author(s):  
Stanley L. Barnwell ◽  
Randall T. Higashida ◽  
Van V. Halbach ◽  
Christopher F. Dowd ◽  
Grant B. Hieshima
Keyword(s):  
Sinus Thrombosis ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Transverse Sinus ◽  
Clinical Findings ◽  
Dural Sinus ◽  
Clot Lysis ◽  
Dural Sinus Thrombosis ◽  
Patients Âgés ◽  
Cranial Nerve Palsies

Abstract Three patients, ages 51 to 71 years, sought treatment for symptomatic dural sinus thrombosis with occlusion and were treated by direct sinus perfusion with urokinase. All three patients had a dural arteriovenous fistula; one involved the inferior petrosal sinus and two involved the transverse sinus. Clinical findings included papilledema, diminished visual acuity, decreased mentation, and cranial nerve palsies. Diagnosis was made by cerebral arteriography and confirmed by sinus venography. All three patients were treated by a transjugular direct infusion of urokinase. In one patient, a transfemoral venous approach used initially was discontinued because of an infection. The period of continuous infusion for thrombolysis ranged between 4 and 10 days. In two patients, the clinical signs and symptoms improved with angiographic evidence of clot lysis and dural sinus recanalization. Angiography indicated that one patient had a partial resolution of a clot in the torcular herophili and transverse sinus but showed no clinical improvement. These preliminary results suggest that transjugular local infusion of thrombolytic agents can be an effective treatment for symptomatic, thrombosed dural sinuses. This selective lysis avoids thrombolytic effects that could aggravate or produce systemic hemorrhagic complications.

Dural sinus thrombosis and pseudotumor cerebri: unexpected complications of suboccipital craniotomy and translabyrinthine craniectomy

1999 ◽  
Vol 91 (2) ◽  
pp. 192-197 ◽  
Author(s):  
Glenn L. Keiper ◽  
Jonathan D. Sherman ◽  
Thomas A. Tomsick ◽  
John M. Tew
Keyword(s):  
Sinus Thrombosis ◽  
Pseudotumor Cerebri ◽  
Transverse Sinus ◽  
Dural Sinus ◽  
Posterior Fossa Surgery ◽  
Dural Sinus Thrombosis ◽  
Mr Venography ◽  
Content Type ◽  
Suboccipital Craniotomy ◽  
Fine Print

Object. The goal of this study was to document the hazards associated with pseudotumor cerebri resulting from transverse sinus thrombosis after tumor resection. Dural sinus thrombosis is a rare and potentially serious complication of suboccipital craniotomy and translabyrinthine craniectomy. Pseudotumor cerebri may occur when venous hypertension develops secondary to outflow obstruction. Previous research indicates that occlusion of a single transverse sinus is well tolerated when the contralateral sinus remains patent.Methods. The authors report the results in five of a total of 107 patients who underwent suboccipital craniotomy or translabyrinthine craniectomy for resection of a tumor. Postoperatively, these patients developed headache, visual obscuration, and florid papilledema as a result of increased intracranial pressure (ICP). In each patient, the transverse sinus on the treated side was thrombosed; patency of the contralateral sinus was confirmed on magnetic resonance (MR) imaging. Four patients required lumboperitoneal or ventriculoperitoneal shunts and one required medical treatment for increased ICP. All five patients regained their baseline neurological function after treatment. Techniques used to avoid thrombosis during surgery are discussed.Conclusions. First, the status of the transverse and sigmoid sinuses should be documented using MR venography before patients undergo posterior fossa surgery. Second, thrombosis of a transverse or sigmoid sinus may not be tolerated even if the sinus is nondominant; vision-threatening pseudotumor cerebri may result. Third, MR venography is a reliable, noninvasive means of evaluating the venous sinuses. Fourth, if the diagnosis is made shortly after thrombosis, then direct endovascular thrombolysis with urokinase may be a therapeutic option. If the presentation is delayed, then ophthalmological complications of pseudotumor cerebri can be avoided by administration of a combination of acetazolamide, dexamethasone, lumbar puncture, and possibly lumboperitoneal shunt placement.

Dural arteriovenous fistulas masquerading as dural sinus thrombosis

2009 ◽  
Vol 110 (3) ◽  
pp. 514-517 ◽  
Author(s):  
Scott Simon ◽  
Tom Yao ◽  
Arthur J. Ulm ◽  
Benjamin P. Rosenbaum ◽  
Robert A. Mericle
Keyword(s):  
Sinus Thrombosis ◽  
Noninvasive Imaging ◽  
Anticoagulation Therapy ◽  
Transverse Sinus ◽  
Dural Sinus ◽  
Dural Sinus Thrombosis ◽  
Venous Flow ◽  
Arteriovenous Fistulas ◽  
Imaging Results ◽  
Dural Arteriovenous Fistulas

The authors report dural sinus thrombosis diagnosed in 2 patients based on noninvasive imaging results, which were revealed to be dural arteriovenous fistulas (DAVFs) diagnosed using digital subtraction (DS) angiography. The first patient was a 63-year-old man who presented with headaches. Magnetic resonance venography was performed and suggested dural sinus thrombosis of the left transverse sinus and jugular vein. He was administered warfarin anticoagulation therapy but then suffered multiple intracranial hemorrhages. A DS angiogram was requested for a possible dural sinus thrombectomy, but the DS angiogram revealed a DAVF. The patient underwent serial liquid embolization with complete obliteration of the DAVF. The second patient, an 11-year-old boy, also presented with headaches and was diagnosed with dural sinus thrombosis on MR imaging. A DS angiogram was also requested for a possible thrombectomy and revealed a DAVF. This patient underwent serial liquid embolization and eventual operative resection. These reports emphasize that different venous flow abnormalities can appear similar on noninvasive imaging and that proper diagnosis is critical to avoid contraindicated therapies.

Transverse Sinus Thrombosis after Posterior Fossa Surgery for Cerebellar Tumor Treated by Endovascular Thrombectomy

2007 ◽  
Vol 20 (5) ◽  
pp. 562-565
Author(s):  
A. Della Puppa ◽  
L. Tosatto ◽  
P. Amistà ◽  
M. Munari ◽  
R. Scienza
Keyword(s):  
Posterior Fossa ◽  
Sinus Thrombosis ◽  
Rare Complication ◽  
Anticoagulation Therapy ◽  
Young Male ◽  
Transverse Sinus ◽  
Dural Sinus ◽  
Posterior Fossa Surgery ◽  
Cerebellar Tumor ◽  
Dural Sinus Thrombosis

Dural sinus thrombosis is a rare complication after posterior fossa surgery, particularly in cerebellar tumour surgery. The authors describe the case of a young male patient who presented a postoperative neurological deterioration due to transverse sinus thrombosis after surgery for cerebellar medulloblastoma. He was treated by mechanical clot thrombectomy using an endovascular catch system technique without anticoagulation therapy. Final angiographic recanalization was obtained. This kind of endoluminal mechanical revascularization is an efficacious method to treat dural sinus thrombosis during perioperative time but speed in diagnosis is crucial for clinical outcome.

Sigmoid Sinus Thrombosis Associated with Internal Jugular Venous Occlusion: Direct Thrombolytic Treatment

1996 ◽  
Vol 3 (3) ◽  
pp. 306-314 ◽  
Author(s):  
Melissa B. Gurley ◽  
Teresa S. King ◽  
Fong Y. Tsai
Keyword(s):  
Internal Jugular Vein ◽  
Jugular Vein ◽  
Sinus Thrombosis ◽  
Balloon Dilation ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Sigmoid Sinus ◽  
Dural Sinus ◽  
Jugular Vein Thrombosis ◽  
Transfemoral Approach

Purpose: To report our experience with transfemoral direct venous thrombolysis and angioplasty to treat central venous and dural sinus occlusion. The cases presented are rare examples of internal jugular occlusion associated with sigmoid sinus thrombosis. Methods and Results: Two middle-aged, symptomatic female patients were diagnosed with sigmoid sinus and internal jugular vein thrombosis. Venography was performed from a contralateral transfemoral approach, followed immediately by urokinase infusion directly to the occlusion using an intermittent “burst-bolus” technique. Successful thrombolysis of the sigmoid sinus and internal jugular vein was documented in both patients. In one case, a venous stenosis was treated with balloon angioplasty. Clinical signs and symptoms resolved in both patients. Conclusions: Occluded dural sinuses and central veins can be treated with direct administration of thrombolytic agents. When an underlying stenosis is identified, balloon dilation should be used to reduce the likelihood of recurrence.

Dural Sinus Thrombosis Complicating Subclavian Vein Catheterization: Treatment With Local Thrombolysis

PEDIATRICS ◽  
1995 ◽  
Vol 95 (1) ◽  
pp. 138-140
Author(s):  
Bassam M. Gebara ◽  
Mark G. Goetting ◽  
Ay-Ming Wang
Keyword(s):  
Internal Jugular Vein ◽  
Subclavian Vein ◽  
Jugular Vein ◽  
Sinus Thrombosis ◽  
Transverse Sinus ◽  
Dural Sinus ◽  
Dural Sinus Thrombosis ◽  
Jugular Vein Thrombosis ◽  
Vein Thrombosis ◽  
Vein Catheterization

Local venous thrombosis is a known complication of subclavian vein catheterization.1,2 The clot can extend to the noncatheterized ipsilateral internal jugular vein.3,4 It is usually asymptomatic, however, signs of venous congestion can occur. Dural sinus thrombosis has been reported in association with retrograd catheterization of the internal jugular vein,5 but not the subclavian vein. We report a case of symptomatic right sigmoid sinus, transverse sinus, and bilateral internal jugular vein thrombosis without subclavian vein thrombosis in an infant few hours after placement of right subclavian vein catheter. CASE REPORT A 9-week-old girl was seen in the emergency room for lethargy, cyanosis, and apnea.

scholarly journals Decompressive surgery in malignant dural sinus thrombosis: report of 3 cases and review of the literature

2009 ◽  
Vol 26 (6) ◽  
pp. E5 ◽  
Author(s):  
Luigi A. Lanterna ◽  
Paolo Gritti ◽  
Ornella Manara ◽  
Gianluca Grimod ◽  
Gianmario Bortolotti ◽  
...  
Keyword(s):  
Intracranial Hypertension ◽  
Sinus Thrombosis ◽  
Clinical Signs ◽  
Dural Sinus ◽  
Dural Sinus Thrombosis ◽  
Brain Herniation ◽  
Sagittal Sinus ◽  
Clot Removal ◽  
Life Threatening ◽  
Middle Aged Adults

Cerebral venous and dural sinus thrombosis (CVDST) is a rare cause of stroke in young and middle-aged adults. When the clinical course is complicated by uncontrollable intracranial hypertension and brainstem compression due to edema or cerebral hemorrhage, the prognosis is poor. The authors evaluated the therapeutic role of surgical decompression in patients with clinical signs of impending herniation. Cerebral venous and dural sinus thrombosis complicated by impending brain herniation a very rare, life-threatening but potentially treatable clinical condition. Three patients with pupillary signs of transtentorial herniation due to brain edema and hemorrhage caused by CVDST (superior sagittal sinus in 1 patient and transverse and sigmoid sinus in 2 patients) were treated surgically. The intervention consisted of clot removal, infarcted tissue resection, and frontotemporoparietooccipital craniectomy with duraplasty. According to the Glasgow Outcome Scale, 2 patients were classified as having good recovery and 1, moderate disability. The results of neuropsychological assessment were normal in 2 patients and demonstrated a partial neuropsychological deficit (neglect) in the other. Surgery may be indicated in selected patients with CVDST whose condition is deteriorating because of intractable intracranial hypertension and impending brain herniation.

Rheolytic Catheter and Thrombolysis of Dural Venous Sinus Thrombosis: A Case Series

Neurosurgery ◽  
2001 ◽  
Vol 48 (3) ◽  
pp. 487-494 ◽  
Author(s):  
Michael D. Baker ◽  
Michael J. Opatowsky ◽  
John A. Wilson ◽  
Steven S. Glazier ◽  
P. Pearse Morris
Keyword(s):  
Sinus Thrombosis ◽  
Case Series ◽  
Neurological Deficits ◽  
Dural Sinus ◽  
Clot Lysis ◽  
High Morbidity ◽  
Variable Degree ◽  
Imaging Features ◽  
Dural Sinus Thrombosis ◽  
Balloon Catheters

Abstract OBJECTIVE The high morbidity and mortality rates associated with dural sinus thrombosis may be heightened by a delay in diagnosis, which necessitates prompt and effective treatment. Traditional treatment consists of the initiation of systemic anticoagulation with heparin and, more recently, regional thrombolysis with direct endovascular infusion of thrombolytic agents. We report our experience in a series of five patients in whom we accomplished mechanical clot lysis with the combination of a rheolytic device and balloon catheters. METHODS Five patients with dural sinus thrombosis were treated with a combination of pharmacological and mechanical thrombolysis with the 5-French AngioJet rheolytic catheter (Possis Medical, Minneapolis, MN) and balloon catheters. The success of the procedure was determined by resolution of or improvement in the patient's neurological examination results and imaging features. RESULTS All five patients demonstrated immediate improvement as observed on imaging studies or in terms of neurological status. Three patients required more than one intervention, and all but one patient continued to improve after the final intervention. Two of the five patients continued to experience mild residual neurological deficits, and two patients experienced complete recovery. The fifth patient had a delayed recurrence of thrombosis that required multiple interventions, and the patient has significant neurological deficits. Navigation of the dural sinuses was possible in all patients with the use of a microcatheter and was possible to a variable degree with the rheolytic catheter. Known complications of the procedures included two pseudoaneurysms at the femoral puncture site. CONCLUSION Mechanical clot lysis is a powerful technique for immediate restoration of antegrade venous flow in dural sinus thrombosis. In most patients, the superior sagittal sinuses and contralateral transverse sinuses could be accessed with the 5-French rheolytic catheter.

Extensive Experience with Dural Sinus Thrombosis

Neurosurgery ◽  
2003 ◽  
Vol 52 (3) ◽  
pp. 534-544 ◽  
Author(s):  
Scott W. Soleau ◽  
Richard Schmidt ◽  
Steve Stevens ◽  
Anne Osborn ◽  
Joel D. MacDonald
Keyword(s):  
Clinical Improvement ◽  
Sinus Thrombosis ◽  
Treatment Strategies ◽  
Retrospective Chart Review ◽  
Dural Sinus ◽  
Hemorrhagic Complication ◽  
Dural Sinus Thrombosis ◽  
Extensive Experience ◽  
Medical Observation ◽  
Hemorrhagic Complications

Abstract OBJECTIVE Dural sinus thrombosis (DST) is an uncommon cause of stroke. The safest and most effective therapy for DST has not been conclusively identified. METHODS A retrospective chart review of data for 31 patients who were treated for DST at our institution between 1992 and 2001 was performed. Four treatment strategies were identified, i.e., 1) medical observation only, 2) systemic anticoagulation (AC) therapy with heparin, 3) endovascular chemical thrombolysis with urokinase or tissue plasminogen activator and concurrent systemic AC therapy, and 4) mechanical endovascular clot thrombolysis with concurrent systemic AC therapy. Complications and clinical outcomes were assessed for each group. RESULTS Patients treated solely with medical observation fared the worst; four of five patients experienced intracranial hemorrhagic complications, and only two of five exhibited clinical improvement. Patients who received systemic AC therapy experienced no hemorrhagic complications, even when pretreatment hemorrhage was present; 75% (six of eight patients) exhibited improvement with AC therapy alone. Chemical thrombolysis was very effective in restoring sinus patency (90% of patients); however, 30% of patients (3 of 10 patients) experienced hemorrhagic complications. Sixty percent of patients (6 of 10 patients) who underwent chemical thrombolysis exhibited clinical improvement. Patients who underwent mechanical thrombectomies demonstrated a low hemorrhagic complication rate, and most (88%) made good recoveries. CONCLUSION Therapy directed at the underlying clot in DST must begin without delay. Our results suggest that supportive medical management of DST, without therapy directed at the clot or clotting process, is not effective. Systemic AC therapy, even in the presence of intracerebral hemorrhage, seems to be safe. Heparin can be safely titrated to yield partial thromboplastin times of 60 to 70 seconds. Chemical clot thrombolysis is efficacious in opening occluded sinuses but may cause intracranial hemorrhage. We currently recommend either systemic AC therapy or systemic AC therapy in conjunction with mechanical clot thrombectomy as a safe effective treatment for DST.

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