| Background and Objective:Cerebral venous thrombosis(CVT)is a kind of cerebral vascular disease,which occurs in cerebral vein or dural venous sinus,and then causes its stenosis and occlusion,leading to cerebral venous circulation disorder.This particular disease,which has a low incidence and complex etiology,can also cause different types of brain injury,or hydrocephalus,isolated intracranial hypertension and so on.Its clinical symptoms are varied and lack specificity.The diagnosis is highly dependent on the cerebral venous imaging examination,and is often prone to missed diagnosis,misdiagnosis and varying degrees of diagnostic delay.Although most patients can be functionally independent after standard anticoagulant therapy,some patients still deteriorate rapidly and have poor outcomes,which is difficult to predict.For this group of patients with severe CVT,there are still no effective prevention and treatment measures.Animal experiments confirmed that cerebral venous collateral circulation is closely related to the occurrence of brain damage.However,clinical studies on cerebral venous collateral circulation are rare and only a few retrospective studies are available.At present,conclusions have not been unified and there is a lack of accepted protocols for assessing venous collaterals.The purpose of this study was to establish an evaluation system of cerebral collateral circulation in cerebral venous system thrombosis,to explore the correlation between venous collateral circulation and epidemiology,imaging,clinical symptoms and prognosis after CVT,and to analyze the prognostic factors related to the prognosis of patients with CVT,so as to help identify these patients with possible poor prognosis and take aggressive intervention to improve the outcome of patients.Methods:This study included patients with confirmed cerebral venous thrombosis who were admitted to the Department of Neurosurgery of our hospital between December 2011 and August 2018.All patients were admitted to the hospital for the first time to collect routine DSA and delayed rotational venography data.After reviewing and summarizing a large number of literatures,the collateral venous circulation scale(CVCS)was developed.DSA data were scored blindly by two neurointerventionalists,and those with different initial scores were referred to a third neurointerventionist for re-analysis and final results were discussed togetherResults:A total of 32 patients with cerebral venous thrombosis were included in this study.CVCS was 0 in 28%(9/32),1 in 41%(13/32),and 2 in 31%(10/32).53%patients had hemorrhage or ischemic parenchymal damage,59%patients had different degrees and types of neurological deficit symptoms.At 90-day follow-up,severe disability or death(mRS 4-6)in 13%,Mild to moderate disability(mRS 2-3)in 13%,and complete recovery(mRS 0-1)in 75%.CVCS was significantly associated with the incidence of parenchymal damage(P<0.001,rs =-0.70),with the proportion of neurological deficits(P<0.001,rs =-0.80),and with 90-day follow-up(P<0.001,rs =-0.60).Factors associated with outcome at 90-day follow-up were parenchymal hemorrhage,deep venous system thrombosis,coma,and in-hospital craniotomy,and patients with these factors were more likely to have poor outcomes.Conclusions:The lower the CVCS in patients with CVT,the worse the clinical outcomes.Patients with parenchymal hemorrhage,deep venous system thrombosis,coma,or craniectomy during hospitalization are more likely to have poor outcomes. |
