REVERSIBILITY OF SEVERE SAGITTAL SINUS THROMBOSIS WITH OPEN SURGICAL THROMBECTOMY COMBINED WITH LOCAL INFUSION OF TISSUE-PLASMINOGEN ACTIVATOR - TECHNICAL CASE-REPORT
K. Ekseth et al., REVERSIBILITY OF SEVERE SAGITTAL SINUS THROMBOSIS WITH OPEN SURGICAL THROMBECTOMY COMBINED WITH LOCAL INFUSION OF TISSUE-PLASMINOGEN ACTIVATOR - TECHNICAL CASE-REPORT, Neurosurgery, 43(4), 1998, pp. 960-964
OBJECTIVE: To explore the controversial issue of anticoagulant therapy
and indications for surgery in association with severe sinus thrombos
is. METHODS: During the last 4 years, we have treated three patients w
ith severe sinus thrombosis of the dural sinuses. All three patients r
eceived systemic anticoagulant therapy and, after experiencing neurolo
gical deterioration, underwent open thrombectomy and local thrombolysi
s. After the operation, aggressive intensive care was given and includ
ed cerebral perfusion monitoring, barbiturate administration, hyperven
tilation, and osmotherapy. The treatment was guided by repeated neuror
adiological investigations. RESULTS: All three patients returned to th
eir normal lives. CONCLUSION: Intracranial sinus thrombosis, even in t
he worst neurological state, should be treated aggressively. A corners
tone in treatment is systemic anticoagulant therapy and repeated neuro
radiological studies. When, despite adequate anticoagulant therapy and
intensive care, neurological deterioration occurs, a combination of o
pen thrombectomy and local thrombolytic therapy should be considered.