Reversibility of Severe Sagittal Sinus Thrombosis with Open Surgical Thrombectomy Combined with Local Infusion of Tissue Plasminogen Activator: Technical Case Report

Reversibility of Severe Sagittal Sinus Thrombosis with Open Surgical Thrombectomy Combined with... OBJECTIVE:To explore the controversial issue of anticoagulant therapy and indications for surgery in association with severe sinus thrombosis.METHODS:During the last 4 years, we have treated three patients with severe sinus thrombosis of the dural sinuses. All three patients received systemic anticoagulant therapy and, after experiencing neurological deterioration, underwent open thrombectomy and local thrombolysis. After the operation, aggressive intensive care was given and included cerebral perfusion monitoring, barbiturate administration, hyperventilation, and osmotherapy. The treatment was guided by repeated neuroradiological investigations.RESULTS:All three patients returned to their normal lives.CONCLUSION:Intracranial sinus thrombosis, even in the worst neurological state, should be treated aggressively. A cornerstone in treatment is systemic anticoagulant therapy and repeated neuroradiological studies. When, despite adequate anticoagulant therapy and intensive care, neurological deterioration occurs, a combination of open thrombectomy and local thrombolytic therapy should be considered. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Neurosurgery Oxford University Press

Reversibility of Severe Sagittal Sinus Thrombosis with Open Surgical Thrombectomy Combined with Local Infusion of Tissue Plasminogen Activator: Technical Case Report

Reversibility of Severe Sagittal Sinus Thrombosis with Open Surgical Thrombectomy Combined with Local Infusion of Tissue Plasminogen Activator: Technical Case Report

960 Ekseth et al h a v e d e m o n s t r a t e d t h e b e n e f i t s of Reversibility of Severe Sagittal Sinus o p e n s u r g i c a l t h r o m b e c t o m y com­ b i n e d w i t h e n d o v a s c u l a r th rom b olytic Thrombosis with Open Surgical t h e r a p y ( 2 0 , 2 5 , 2 6 ) . W e d e s c r i b e t h r e e p a t i e n t s w h o were Thrombectomy Combined with Local t r e a t e d u s i n g s u r g e r y a n d fibrinolysis, a n d w e d e s c r i b e , in d e t a i l , th e third case, Infusion of Tissue Plasminogen Activator: in w h i c h t h e p a t i e n t w a s in p o o r neuro­ l o g i c a l s t a t u s a n d h a d r e l e v a n t problems. Technical Case Report W e a l s o r e v i e w th e r e l e v a n t literature. CASE REPORTS Kare Ekseth, M.D., Sverre Bostrom, M.D., Patient 1 Magnus Vegfors, M.D., Ph.D. T h i s 2 7 - y e a r - o l d f e m a l e patient, who Departments of Neurosurgery (KE, SB) and Anesthesiology (MV), University Hospital, Linkoping, Sweden s m o k e d c i g a r e t t e s a n d w a s u s i n g oral c o n t r a c e p t i v e s , h a d a 4 - w e e k history of f a t i g u e a n d w a s a d m i t t e d to the neuro­ l o g i c a l d e p a r t m e n t w h e n s h e developed O BJECTIVE: To explore the controversial issue of anticoagulant therapy and n e c k r i g i d i t y a n d f e v e r . T h e results of a indications for surgery in association with severe sinus thrombosis. b l o o d c o u n t a n d c l o t t i n g s c r e e n , includ­ METHODS: During the last 4 years, we have treated three patients with severe i n g p r o t e i n C a n d a n t i t h r o m b i n III, were sinus thrombosis of the dural sinuses. All three patients received systemic n o r m a l . T h e n e x t d a y , t h e p a t i e n t devel­ anticoagulant therapy and, after experiencing neurological deterioration, o p e d t e t r a p a r e s i s a n d t h e n Jacksonian s e i z u r e s . M a n n i t o l a n d antiepileptic underwent open...
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Publisher
Oxford University Press
Copyright
© Published by Oxford University Press.
ISSN
0148-396X
eISSN
1524-4040
D.O.I.
10.1097/00006123-199810000-00144
Publisher site
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Abstract

OBJECTIVE:To explore the controversial issue of anticoagulant therapy and indications for surgery in association with severe sinus thrombosis.METHODS:During the last 4 years, we have treated three patients with severe sinus thrombosis of the dural sinuses. All three patients received systemic anticoagulant therapy and, after experiencing neurological deterioration, underwent open thrombectomy and local thrombolysis. After the operation, aggressive intensive care was given and included cerebral perfusion monitoring, barbiturate administration, hyperventilation, and osmotherapy. The treatment was guided by repeated neuroradiological investigations.RESULTS:All three patients returned to their normal lives.CONCLUSION:Intracranial sinus thrombosis, even in the worst neurological state, should be treated aggressively. A cornerstone in treatment is systemic anticoagulant therapy and repeated neuroradiological studies. When, despite adequate anticoagulant therapy and intensive care, neurological deterioration occurs, a combination of open thrombectomy and local thrombolytic therapy should be considered.

Journal

NeurosurgeryOxford University Press

Published: Oct 1, 1998

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