Near-infrared spectroscopy monitored cerebral venous thrombolysis

Background: Cerebral venous thrombosis is a clinical entity which is readil y diagnosed with the advent of modern imaging techniques. Anticoagulation i s now a standard therapy, but more recent treatment strategies have include d endovascular thrombolysis. While the endpoint of this intervention both c linically and radiographically has not been defined, noninvasive monitoring techniques may add further objective measures of treatment response. Clini cal Presentation: We present a patient with a four day history of worsening headache and papilledema on exam. Superior sagittal, straight, and bilater al transverse sinus thromboses were identified on computed tomography and a ngiography. Intervention: Emergent endovascular thrombolysis by a transveno us approach re-established venous patency and resulted in immediate resolut ion of the patient's symptoms. Cerebral oximetry by near-infrared spectrosc opy was utilized during the procedure, and changes in chromophore concentra tions correlated directly with angiographic and clinical resolution of the thrombosis. Conclusion: Near-infrared spectroscopy can provide continuous f eedback during thrombolytic therapy in cerebral venous thrombosis and may h elp define endpoints of such intervention.