REVERSIBILITY OF SEVERE SAGITTAL SINUS THROMBOSIS WITH OPEN SURGICAL THROMBECTOMY COMBINED WITH LOCAL INFUSION OF TISSUE-PLASMINOGEN ACTIVATOR - TECHNICAL CASE-REPORT

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.