Dural sinus mechanical thrombectomy and continuous local rt-PA infusion in a child with refractory intracranial hypertension and progressive visual loss: A case report.
Dural sinus thrombosis
Intracranial hypertension
Recombinant tissue plasminogen activator
Thrombectomy
Vision
Journal
Surgical neurology international
ISSN: 2229-5097
Titre abrégé: Surg Neurol Int
Pays: United States
ID NLM: 101535836
Informations de publication
Date de publication:
2020
2020
Historique:
received:
30
04
2020
accepted:
05
08
2020
entrez:
7
10
2020
pubmed:
8
10
2020
medline:
8
10
2020
Statut:
epublish
Résumé
Children with intracranial hypertension are at risk for visual loss and their visual function must be closely monitored. Surgery with the insertion of a ventriculoperitoneal shunt is imperative when vision is threatened. Herein, we report a case of a 5-year-old boy whose refractory intracranial hypertension and severe, progressive visual loss (secondary to a chronic, otogenic, right sigmoid sinus thrombosis, and a contralateral sinus tight stenosis) were resolved by a combination of continuous (6 h), locoregional, infusion of recombinant tissue plasminogen activator (rt-PA), and mechanical thrombectomy. The association of in loco and continuous infusion of recombinant tissue plasminogen activator (rt- PA) with mechanical thrombectomy resulted in effective in partially reopening the occluded sinus and facilitating a good clinical recovery. This combined endovascular approach may represent an alternative, less invasive, therapeutic option to surgery in children with intracranial hypertension caused by chronic cerebral venous sinus thrombosis.
Sections du résumé
BACKGROUND
BACKGROUND
Children with intracranial hypertension are at risk for visual loss and their visual function must be closely monitored. Surgery with the insertion of a ventriculoperitoneal shunt is imperative when vision is threatened.
CASE DESCRIPTION
METHODS
Herein, we report a case of a 5-year-old boy whose refractory intracranial hypertension and severe, progressive visual loss (secondary to a chronic, otogenic, right sigmoid sinus thrombosis, and a contralateral sinus tight stenosis) were resolved by a combination of continuous (6 h), locoregional, infusion of recombinant tissue plasminogen activator (rt-PA), and mechanical thrombectomy.
CONCLUSION
CONCLUSIONS
The association of in loco and continuous infusion of recombinant tissue plasminogen activator (rt- PA) with mechanical thrombectomy resulted in effective in partially reopening the occluded sinus and facilitating a good clinical recovery. This combined endovascular approach may represent an alternative, less invasive, therapeutic option to surgery in children with intracranial hypertension caused by chronic cerebral venous sinus thrombosis.
Identifiants
pubmed: 33024591
doi: 10.25259/SNI_236_2020
pii: SNI-11-253
pmc: PMC7533100
doi:
Types de publication
Case Reports
Langues
eng
Pagination
253Informations de copyright
Copyright: © 2020 Surgical Neurology International.
Déclaration de conflit d'intérêts
There are no conflicts of interest.
Références
AJNR Am J Neuroradiol. 2015 Mar;36(3):552-6
pubmed: 25324495
J Child Neurol. 2012 Mar;27(3):337-45
pubmed: 22190502
Acta Neurochir (Wien). 2010 May;152(5):911-6
pubmed: 20016918
Pediatr Neurol. 1994 Feb;10(1):78-80
pubmed: 8198679
J Neurosurg Pediatr. 2013 Feb;11(2):140-3
pubmed: 23198843
Neurocrit Care. 2008;9(1):17-26
pubmed: 18250978
Pediatr Neurol. 2013 Nov;49(5):305-12
pubmed: 24139531
Pediatrics. 1995 Jan;95(1):138-40
pubmed: 7770293
J Pak Med Assoc. 2006 Nov;56(11):555-6
pubmed: 17183991
Neurology. 2004 Oct 12;63(7):1314-6
pubmed: 15477563