Clinical And Imaging Evaluation Of Venous Circulation Compensation In Patients With Cerebral Venous Sinus Thrombosis

Background and purpose:Cerebral venous sinus thrombosis（CVST）is a special form of cerebrovascular disease with venous return disorders.With the development of imaging technology,its morbidity has increased,accordingly its incidence rate has also increased.Due to the variety of clinical symptoms and lack of specificity,it is easy to misdiagnosis and mistreatment,ultimately increasing the occurrence of adverse outcomes.In acute arterial infarction,the clinical prognosis and outcome of interventional therapy are closely related to the level of collateral circulation.CVST is also a thrombotic disease,how is the compensation of its venous collaterals?Can it affect the prognosis?Few studies have been done on venous circulation compensation for CVST,and even less on its extracranial venous circulation.The purpose of this study was to quantitatively evaluate the compensation of extracranial venous circulation in patients with CVST,explore the correlation between extracranial venous circulation compensation and clinical,further explore the influence of extracranial venous circulation compensation and clinical related factors on the prognosis.The research aims to assist clinical identification of high-risk factors for a poor prognosis,achieve early intervention,formulate more individualized treatment plans,and improve patient outcomes.Material and Methods:According to strict inclusion and exclusion criteria,65 patients diagnosed with CVST who were admitted to the Department of Neurology of the First Affiliated Hospital of Jilin University from January 2019 to June 2021 were collected.MRV information was collected from all enrolled patients and extracranial veins were extracted using 3D Slicer to derive their volume.Detailed records of age,gender,course of disease,risk factors,clinical symptoms,CVST location,presence of brain parenchyma injury（cerebral hemorrhage/cerebral infarction）,lumbar puncture pressure,length of hospital stay,and treatment were recorded.Results:In this study,extracranial venous circulation compensation was found to be in all CVST patients,with a mean vessel volume of 7.27±3.29 cm~3.And its volume was significantly different between different age groups,whether there were infectious factors and different intracranial pressure groups（P<0.05）.The left transverse sinus and left sigmoid sinus thrombosis with or without internal jugular vein thrombosis had statistical significance with the compensatory volume of the right extracranial venous circulation（P<0.05）.There was also statistical significance between the left transverse sinus and left sigmoid sinus thrombosis patients with or without internal jugular vein thrombosis and the left extracranial venous circulation（P<0.05）.Symptoms of high intracranial pressure,neurological deficit symptoms,disturbance of consciousness,motor dysfunction,language impairment,epilepsy symptoms,transverse sinus thrombosis,intracranial pressure≥400mm H₂O,extracranial venous circulation compensated volume and other factors are associated with good prognosis and poor prognosis.There was a statistical difference（P<0.05）.After multivariate logistic regression,loss of consciousness,motor dysfunction,compensated volume of extracranial venous circulation,and intracranial pressure≥400 mm H₂O were independent risk factors for poor prognosis in patients with CVST.Conclusions:1.Extracranial venous circulation compensation is prevalent in patients with CVST.The extracranial venous circulation found in this study is mainly divided into four parts:the facial vein,the superficial temporal vein,the retroauricular vein,and the occipital vein.2.Sufficient compensation of extracranial venous circulation is beneficial to the prognosis of patients.And poor compensation of extracranial venous circulation is an independent risk factor for poor prognosis.3.When the transverse sinus or sigmoid sinus on one side is associated with or without ipsilateral internal jugular vein thrombosis,extracranial venous compensation is mainly performed through the contralateral side.4.Factors influencing extracranial venous circulation compensation include age,infectious factors,and intracranial pressure≥400 mm H₂O.