TREATMENT OF DURAL SINUS THROMBOSIS USING SELECTIVE CATHETERIZATION AND UROKINASE

Thrombosis of the cerebral dural venous sinuses, cortical draining vei ns, and deep cerebral veins is a rare clinical finding. Because of its low incidence and multiple etiologies, the optimum therapy for this c ondition will only be elucidated by a multicenter, randomized prospect ive study. At our institution, we favor early and aggressive managemen t of cerebral venous sinus thrombosis with transfemoral, venous intrad ural infusions of the fibrinolytic agent urokinase. To date, treatment of only 13 patients using this technique has been reported in the Eng lish literature. This report adds 12 more such treated patients. Despi te the presence of preinfusion infarcts in 5 patients, four of which w ere hemorrhagic, we incurred no major therapeutic morbidity. Functiona l sinus patency was achieved in 11 of 12 patients, with our only true failure occurring in an individual with symptoms of at least 2 months' duration. Good to excellent clinical outcome was achieved in 10 of 11 patients (one newborn had inadequate follow-up).