In our hospital, when multiple sinus occlusions and a delay in circulation time are observed in cases of sinus thrombosis, local fibrinolytic therapy (LFT) is used adjunctively with the continuous infusion of heparin, irrespective of disease severity. In this study, we examined the usefulness of LFT in sinus thrombosis. Fifteen consecutive patients (age range: 25‒61 years, mean: 45.3 years; 8 males and 7 females) diagnosed with sinus thrombosis based on CT/MRI findings were included in this study. Of these patients, one had a cerebral infarction, and six experienced cerebral hemorrhage. The superior sagittal/transverse-sigmoid/straight sinuses were affected in five cases, the superior sagittal sinus in three cases, and the transverse-sigmoid sinuses in seven cases. The symptoms observed were as follows: headache in six cases, consciousness disturbance in five cases, aphasia in two cases, and convulsion in two cases. The underlying causes were as follows: contraceptive use in three cases, malignancy in two cases, coagulation disorder in two cases, and infection in two cases. In six cases, the underlying cause was unknown. Local fibrinolysis was used when multiple sinus occlusions and a delay in circulation time were noted. Based on this criterion, six patients were treated with LFT, and nine with only heparin treatment. A maximum of 360,000 units of urokinase (UK) were administered as part of the LFT, and additional mechanical disruption was also performed; heparin was administered such that the activated partial thromboplastin time reached approximately 1.5 times the previous value. If partial recanalization was achieved, LFT was discontinued. In the LFT group, the average quantity of UK administered was 260,000 units. In this group, three out of six patients were treated using a balloon catheter for clot disruption. Partial recanalization was obtained in all cases, and no complications were observed. Outcomes evaluated using the modified Rankin Scale (mRS) 90 days post-treatment revealed that in total, there were eight patients with an mRS score of 0, four with a score of 1, one with a score of 2, one with a score of 3, and one with a score of 4. Thirteen cases (87%) showed a favorable mRS outcome of 0‒2, and the two cases with an mRS result of 3‒4 were in the heparin treatment group. It is useful to combine heparin therapy with early LFT for sinus thrombosis with multiple sinus occlusions, irrespective of disease severity. LFT was considered not to aim for complete recanalization, but to be positioned as an adjuvant therapy and keep safe procedure, and it was concluded that good results were obtained.
"},{"@language":"ja","@value":"当院では脳静脈洞血栓症に対し，複数の静脈洞閉塞と循環時間の遅延を認めた場合，軽症でもヘパリンの持続静注に局所線溶療法を追加している．この治療法の有用性を検討した．脳静脈洞血栓症と診断された連続15例を対象とした．局所線溶療法ではUK 36万単位を上限として投与し，機械的破砕も併用した．部分再開通が得られれば手技を終了した．ヘパリンはAPTTが前値の約1.5倍となるように投与した．年齢は25‒61（平均45.3）歳，男性８例，女性７例であった．原因疾患は経口避妊薬内服中が３例，悪性腫瘍２例，凝固異常２例，感染２例，不明６例であった．症状は頭痛６例，意識障害５例，失語２例，痙攣２例であり，入院時CT，MRIで脳梗塞を１例，脳出血を６例に認めた．罹患静脈洞については上矢状/横・S状/直静脈洞５例，上矢状静脈洞３例，横・S状静脈洞７例であった．治療法については局所線溶療法追加群が６例，ヘパリン治療群が９例であった．局所線溶療法追加群では平均UK使用量は26万単位であり，６例中３例に破砕時にバルーンを使用した．全例に部分再開通が得られ，合併症は認められなかった．治療成績は90 日後のmRSで評価し，mRS 0が８例，mRS 1が４例，mRS 2が１例，mRS 3が１例，mRS 4が１例であった．mRS 0‒2の予後良好例は13例（87％）であり，mRS 3‒4の２例はヘパリン治療群であった．複数の静脈洞閉塞を伴う脳静脈洞血栓症に対しては，軽症でも早期に局所線溶療法をヘパリン治療に追加することは有用である．局所線溶療法では部分再開通が得られれば良く，補助療法と考えて安全な操作にとどめることが重要であり，良好な成績が得られたものと考えられた．
"}],"abstractLicenseFlag":"disallow"}],"creator":[{"@id":"https://cir.nii.ac.jp/crid/1410009224238428161","@type":"Researcher","personIdentifier":[{"@type":"NRID","@value":"9000399221784"}],"foaf:name":[{"@language":"ja","@value":"南出 尚人"},{"@language":"en","@value":"Minamide Hisato"}],"jpcoar:affiliationName":[{"@language":"en","@value":"Department of Neurosurgery, Kanazawa Municipal Hospital"}]},{"@id":"https://cir.nii.ac.jp/crid/1410009224238428160","@type":"Researcher","personIdentifier":[{"@type":"NRID","@value":"9000399221785"}],"foaf:name":[{"@language":"ja","@value":"池田 正人"},{"@language":"en","@value":"Ikeda Masato"}],"jpcoar:affiliationName":[{"@language":"en","@value":"Department of Neurosurgery, Kanazawa Municipal Hospital"}]},{"@id":"https://cir.nii.ac.jp/crid/1410009224238428164","@type":"Researcher","personIdentifier":[{"@type":"NRID","@value":"9000399221786"}],"foaf:name":[{"@language":"ja","@value":"佐野 宏樹"},{"@language":"en","@value":"Sano Hiroki"}],"jpcoar:affiliationName":[{"@language":"en","@value":"Department of Neurosurgery, Kanazawa Municipal Hospital"}]},{"@id":"https://cir.nii.ac.jp/crid/1410009224238428163","@type":"Researcher","personIdentifier":[{"@type":"NRID","@value":"9000399221787"}],"foaf:name":[{"@language":"ja","@value":"赤池 秀一"},{"@language":"en","@value":"Akaike Shuuichi"}],"jpcoar:affiliationName":[{"@language":"en","@value":"Department of Neurosurgery, Kanazawa Municipal Hospital"}]},{"@id":"https://cir.nii.ac.jp/crid/1410009224238428162","@type":"Researcher","personIdentifier":[{"@type":"NRID","@value":"9000399221788"}],"foaf:name":[{"@language":"ja","@value":"林 裕"},{"@language":"en","@value":"Hayashi Yutaka"}],"jpcoar:affiliationName":[{"@language":"en","@value":"Department of Neurosurgery, Ishikawa Prefectural Central Hospital"}]}],"publication":{"publicationIdentifier":[{"@type":"PISSN","@value":"13426214"},{"@type":"EISSN","@value":"24340561"},{"@type":"NDL_BIB_ID","@value":"000000103119"},{"@type":"ISSN","@value":"13426214"},{"@type":"LISSN","@value":"13426214"},{"@type":"NCID","@value":"AA11553357"}],"prism:publicationName":[{"@language":"ja","@value":"NEUROSURGICAL EMERGENCY"},{"@language":"en","@value":"NEUROSURGICAL EMERGENCY"},{"@language":"en","@value":"NEUROSURGICAL EMERGENCY"}],"dc:publisher":[{"@language":"en","@value":"Japan Society of Neurosurgical Emergency"},{"@language":"ja","@value":"特定非営利活動法人 日本脳神経外科救急学会 Neurosurgical Emergency"}],"prism:publicationDate":"2018","prism:volume":"23","prism:number":"2","prism:startingPage":"112","prism:endingPage":"120"},"url":[{"@id":"http://id.ndl.go.jp/bib/029416627"},{"@id":"https://ndlsearch.ndl.go.jp/books/R000000004-I029416627"},{"@id":"https://search.jamas.or.jp/link/ui/2019139764"}],"availableAt":"2018","foaf:topic":[{"@id":"https://cir.nii.ac.jp/all?q=dural%20sinus%20thrombosis","dc:title":"dural sinus thrombosis"},{"@id":"https://cir.nii.ac.jp/all?q=local%20fibrinolytic%20therapy","dc:title":"local fibrinolytic therapy"},{"@id":"https://cir.nii.ac.jp/all?q=treatment%20outcome","dc:title":"treatment outcome"},{"@id":"https://cir.nii.ac.jp/all?q=urokinase","dc:title":"urokinase"},{"@id":"https://cir.nii.ac.jp/all?q=mechanical%20thrombolysis","dc:title":"mechanical thrombolysis"},{"@id":"https://cir.nii.ac.jp/all?q=dural%20sinus%20thrombosis","dc:title":"dural sinus thrombosis"},{"@id":"https://cir.nii.ac.jp/all?q=local%20fibrinolytic%20therapy","dc:title":"local fibrinolytic therapy"},{"@id":"https://cir.nii.ac.jp/all?q=treatment%20outcome","dc:title":"treatment outcome"},{"@id":"https://cir.nii.ac.jp/all?q=urokinase","dc:title":"urokinase"},{"@id":"https://cir.nii.ac.jp/all?q=mechanical%20thrombolysis","dc:title":"mechanical thrombolysis"}],"dataSourceIdentifier":[{"@type":"JALC","@value":"oai:japanlinkcenter.org:2006351880"},{"@type":"NDL_SEARCH","@value":"oai:ndlsearch.ndl.go.jp:R000000004-I029416627"},{"@type":"CIA","@value":"130007529629"}]}