脑静脉窦测压指导静脉窦狭窄支架成形术及疗效评价

摘要

目的 评价脑静脉窦微导管测压指导血管内支架成形术治疗静脉窦狭窄的效果.方法 42例诊断为特发性颅内压增高(IIH)伴局限性静脉窦狭窄患者接受微导管静脉窦DSA造影及测压,对其中32例狭窄远近端压力差＞12 mmHg患者行球囊扩张及支架成形术,并复测静脉窦内压.术后评估患者临床症状改善情况,随访观察并发症及症状有无复发,静脉窦是否通畅.结果 32例静脉窦支架成形术均获成功,术后患者颅内高压症状明显缓解,未出现相关并发症.手术前后狭窄远近端压力差比较,差异有统计学意义(P＜0.05),与腰椎穿刺脑脊液压力平行.术后1周患者头痛症状明显改善,视力无明显改善.术后随访12个月,患者临床症状无复发,MRV或DSA复查提示静脉窦主干血流通畅,无再狭窄.结论 脑血管内支架成形术治疗IIH伴静脉窦狭窄患者相对安全、有效,微导管静脉窦测压对适应证选择及疗效评价有临床指导意义.%Objective To evaluate the efficacy of cerebral venous sinus pressure measurement with a microcatheter in guiding stent angioplasty for the treatment of venous sinus stenosis.Methods A total of 42 patients with idiopathic intracranial hypertension (IIH) complicated by localized venous sinus stenosis were enrolled in this study.Microcatheter venous sinus venography with DSA and venous sinus pressure measurement were performed in all patients.Of the 42 patients,the pressure difference between the distal end and the proximal end of venous sinus ＞12 mmHg was found in 32,for whom balloon dilatation together with stent angioplasty was carried out.The venous sinus pressure was measured again after the treatment.The improvement of postoperative clinical symptoms was evaluated.The occurrence of complications,the symptom relapse and the patency of venous sinus were checked up.Results Successful venous sinus stent angioplasty was achieved in all 32 patients.The symptoms of intracranial hypertension were remarkably relieved,and no procedure-related complications occurred.The postoperative pressure difference between the distal end and the proximal end of venous sinus was significantly different from the preoperative one (P＜0.05),and the pressure showed a parallel correlation with the pressure of lumbar puncture.One week after the treatment,the headache was strikingly rclieved although visual acuity showed no obvious improvement.The patients were followed up for 12 months,no recurrence of clinical symptoms was seen,and magnetic resonance venography (MRV) or DSA examination showed that venous sinus blood flow was unobstructed and no restenosis was detected.Conclusion For the treatment of IIH stenosis complicated by localized venous sinus stenosis,endovascular stent angioplasty is relatively safe and effective,and the cerebral venous sinus pressure measurement with a microcatheter is of clinical significance for the selection of suitable patients as well as for the evaluation of curative effect.