ENDOVASCULAR TREATMENT OF TRAUMATIC DURAL SINUS THROMBOSIS - CASE-REPORT

OBJECTIVE: Dural sinus thrombosis has rarely been associated with clos ed head injury. We present a unique case involving the use of endovasc ular thrombolysis in the treatment of traumatic dural sinus thrombosis , which has not been reported. CLINICAL PRESENTATION: A 20-year-old ma le patient suffered a severe closed head injury while skiing. He devel oped refractory elevated intracranial pressure requiring barbiturate c oma. Angiography demonstrated thrombosis of the dominant right transve rse and sigmoid sinuses, with partial thrombosis of the superior sagit tal sinus. Urokinase was administered via a microcatheter within the t hrombus as a bolus of 250,000 units and then as a continuous infusion of 60,000 to 100,000 units per hour for 48 hours. The patient was main tained in a barbiturate coma and heparinized. Serial angiography was p erformed to assess the sinus patency and efficacy of thrombolysis. RES ULTS: After 48 hours of thrombolysis, angiography demonstrated normal patency of the superior sagittal, right transverse, and right sigmoid sinuses. The intracranial pressure decreased after thrombolysis and wa s manageable with conventional techniques. Within 48 hours of the comp leted thrombolysis, the barbiturates were withdrawn and the patient's neurological status rapidly improved until the time of discharge 2 wee ks later. DISCUSSION AND CONCLUSION: This case documents a rare instan ce of traumatic dural sinus thrombosis resulting from a closed head in jury. In addition, endovascular thrombolysis resulted in subsequent op ening of the dural sinuses and effective intracranial pressure managem ent, despite the presence of a hemorrhagic contusion. Heparin was effe ctive in maintaining sinus patency and was used safely in conjunction with urokinase in this setting of head injury.