Direct endovascular thrombolytic therapy for dural sinus thrombosis

S. L. Barnwell, R. T. Higashida, V. V. Halbach, C. F. Dowd, G. B. Hieshima

Research output: Contribution to journalArticle

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Abstract

Three patients, ages 51 to 71 years, sought treatment for symptomatic dural sinus thrombosis with occlusion and were treated by direct sinus perfusion with urokinase. All three patients had a dural arteriovenous fistula; one involved the inferior petrosal sinus and two involved the transverse sinus. Clinical findings included papilledema, diminished visual acuity, decreased mentation, and cranial nerve palsies. Diagnosis was made by cerebral arteriography and confirmed by sinus venography. All three patients were treated by a transjugular direct infusion of urokinase. In one patient, a transfemoral venous approach used initially was discontinued because of an infection. The period of continuous infusion for thrombolysis ranged between 4 and 10 days. In two patients, the clinical signs and symptoms improved with angiographic evidence of clot lysis and dural sinus recanalization. Angiography indicated that one patient had a partial resolution of a clot in the torcular herophili and transverse sinus but showed no clinical improvement. These preliminary results suggest that transjugular local infusion of thrombolytic agents can be an effective treatment for symptomatic, thrombosed dural sinuses. This selective lysis avoids thrombolytic effects that could aggravate or produce systemic hemorrhagic complications.

Original languageEnglish (US)
Pages (from-to)135-142
Number of pages8
JournalNeurosurgery
Volume28
Issue number1
StatePublished - 1991
Externally publishedYes

Fingerprint

Intracranial Sinus Thrombosis
Thrombolytic Therapy
Transverse Sinuses
Urokinase-Type Plasminogen Activator
Angiography
Central Nervous System Vascular Malformations
Cranial Nerve Diseases
Papilledema
Fibrinolytic Agents
Phlebography
Visual Acuity
Signs and Symptoms
Perfusion
Therapeutics
Infection

Keywords

  • Dural arteriovenous fistula
  • Thrombolysis
  • Thrombosis
  • Urokinase

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Barnwell, S. L., Higashida, R. T., Halbach, V. V., Dowd, C. F., & Hieshima, G. B. (1991). Direct endovascular thrombolytic therapy for dural sinus thrombosis. Neurosurgery, 28(1), 135-142.

Direct endovascular thrombolytic therapy for dural sinus thrombosis. / Barnwell, S. L.; Higashida, R. T.; Halbach, V. V.; Dowd, C. F.; Hieshima, G. B.

In: Neurosurgery, Vol. 28, No. 1, 1991, p. 135-142.

Research output: Contribution to journalArticle

Barnwell, SL, Higashida, RT, Halbach, VV, Dowd, CF & Hieshima, GB 1991, 'Direct endovascular thrombolytic therapy for dural sinus thrombosis', Neurosurgery, vol. 28, no. 1, pp. 135-142.
Barnwell SL, Higashida RT, Halbach VV, Dowd CF, Hieshima GB. Direct endovascular thrombolytic therapy for dural sinus thrombosis. Neurosurgery. 1991;28(1):135-142.
Barnwell, S. L. ; Higashida, R. T. ; Halbach, V. V. ; Dowd, C. F. ; Hieshima, G. B. / Direct endovascular thrombolytic therapy for dural sinus thrombosis. In: Neurosurgery. 1991 ; Vol. 28, No. 1. pp. 135-142.
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