RESUMEN
BACKGROUND: Cerebral venous sinus thrombosis is a potentially serious condition affecting 0.56 to 0.67 per 100,000 children annually; adverse outcomes are common. The standard of care is anticoagulation with heparin. A proportion of patients, however, remain in a severe clinical condition and in these, endovascular therapy is an alternative treatment. There is little published literature on the use of endovascular treatments in children with cerebral venous sinus thrombosis. METHODS: We retrospectively reviewed case notes and imaging in a consecutive series of nine children treated using endovascular therapy after diagnosis of cerebral venous sinus thrombosis. Clinical presentation, decision to escalate therapy, methods of recanalization, and clinical outcome were assessed. RESULTS: Nine children were treated (age range 18 months to 16 years). Diagnosis was made by computed tomography, computed tomography venography, magnetic resonance imaging, or magnetic resonance venography. Seven children were in a coma; one had signs of raised intracranial pressure with progressive cranial nerve palsies; and one was drowsy with a fluctuating hemiparesis. Eight children had been treated with heparin without improvement. Several endovascular methods were used including local tissue plasminogen activator, microguidewire and catheter disruption, balloon angioplasty, and thromboaspiration using the Penumbra device. Eight children had good functional outcomes. One child died as a result of uncontrolled intracranial hypertension secondary to cerebral venous sinus thrombosis. CONCLUSION: Endovascular therapy may have a role in the treatment of cerebral venous sinus thrombosis in children when medical therapy has failed and the patient is in a poor clinical condition.
Asunto(s)
Procedimientos Endovasculares/métodos , Trombosis de los Senos Intracraneales/terapia , Adolescente , Niño , Preescolar , Femenino , Humanos , Lactante , Angiografía por Resonancia Magnética , Imagen por Resonancia Magnética , Masculino , Trombosis de los Senos Intracraneales/diagnóstico , Activador de Tejido Plasminógeno/uso terapéutico , Tomógrafos Computarizados por Rayos X , Resultado del TratamientoAsunto(s)
Neoplasias Óseas/complicaciones , Carcinoma/complicaciones , Desplazamiento del Disco Intervertebral/complicaciones , Polirradiculopatía/diagnóstico , Polirradiculopatía/etiología , Neoplasias del Recto/patología , Adulto , Anciano , Anciano de 80 o más Años , Disección Aórtica/complicaciones , Disección Aórtica/diagnóstico por imagen , Aneurisma de la Aorta/complicaciones , Aneurisma de la Aorta/diagnóstico por imagen , Neoplasias Óseas/diagnóstico por imagen , Neoplasias Óseas/secundario , Carcinoma/diagnóstico por imagen , Carcinoma/secundario , Cauda Equina/anatomía & histología , Discitis/complicaciones , Discitis/diagnóstico , Ependimoma/complicaciones , Ependimoma/diagnóstico , Femenino , Fracturas por Compresión/complicaciones , Fracturas por Compresión/diagnóstico , Humanos , Desplazamiento del Disco Intervertebral/diagnóstico , Desplazamiento del Disco Intervertebral/cirugía , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Polirradiculopatía/terapia , Estenosis Espinal/complicaciones , Estenosis Espinal/diagnóstico , Columna Vertebral/anatomía & histología , Tomografía Computarizada por Rayos XRESUMEN
AIM: To assess the efficacy of stereotactic radiosurgery (STRS) for the treatment of dural arteriovenous fistulae (DAVF). MATERIALS AND METHODS: Between November 1987 and December 1998, 17 patients with a total of 18 DAVF were treated with STRS at the National Centre for Stereotactic Radiosurgery, Sheffield. Clinical and radiological data was collected retrospectively from the case notes and radiological records. Two neuroradiologists classified the pre-STRS appearance of the DAVF using the Borden criteria, and reviewed the follow-up imaging. Up to date follow-up was requested from the GPs and referring consultants. RESULTS: In retrospect one DAVF had been misdiagnosed and was excluded from the study. The remaining 17 DAVF were located at the tentorium (6), cavernous sinus (3), right parasellar region (1), floor of left middle cranial fossa (1), midline posterior fossa (1), petrous apex (1) and transverse sinus (4). Ten were Borden type I, four were type II, three were type III. Follow-up angiography was available for 13 patients; 10 DAVF were completely obliterated, two showed considerable reduction in size, one showed deterioration. Clinical follow-up was available for 14 of the 16 patients. CONCLUSION: Stereotactic radiosurgery can successfully obliterate DAVF with few side effects.