Endovascular treatment of traumatic dural sinus thrombosis: case report.
OBJECTIVE
Dural sinus thrombosis has rarely been associated with closed head injury. We present a unique case involving the use of endovascular thrombolysis in the treatment of traumatic dural sinus thrombosis, which has not been reported.


METHODS
A 20-year-old male patient suffered a severe closed head injury while skiing. He developed refractory elevated intracranial pressure requiring barbiturate coma. Angiography demonstrated thrombosis of the dominant right transverse and sigmoid sinuses, with partial thrombosis of the superior sagittal sinus. Urokinase was administered via a microcatheter within the thrombus as a bolus of 250,000 units and then as a continuous infusion of 60,000 to 100,000 units per hour for 48 hours. The patient was maintained in a barbiturate coma and heparinized. Serial angiography was performed to assess the sinus patency and efficacy of thrombolysis.


RESULTS
After 48 hours of thrombolysis, angiography demonstrated normal patency of the superior sagittal, right transverse, and right sigmoid sinuses. The intracranial pressure decreased after thrombolysis and was manageable with conventional techniques. Within 48 hours of the completed thrombolysis, the barbiturates were withdrawn and the patient's neurological status rapidly improved until the time of discharge 2 weeks later.


CONCLUSIONS
This case documents a rare instance of traumatic dural sinus thrombosis resulting from a closed head injury. In addition, endovascular thrombolysis resulted in subsequent opening of the dural sinuses and effective intracranial pressure management, despite the presence of a hemorrhagic contusion. Heparin was effective in maintaining sinus patency and was used safely in conjunction with urokinase in this setting of head injury.
Kuether
T A
TA
Department of Neurosurgery, Oregon Health Sciences University, Portland 97201-3098, USA.
O'Neill
O
O
Nesbit
G M
GM
Barnwell
S L
SL
D000058:Accidental Falls; D000328:Adult; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use; D001924:Brain Concussion / Q000209:etiology*; D002405:Catheterization, Central Venous; D002543:Cerebral Hemorrhage / Q000209:etiology*; D000075202:Contraindications; D003392:Cranial Sinuses / Q000293:injuries*; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D006493:Heparin / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007262:Infusions, Intravenous; D019586:Intracranial Hypertension / Q000209:etiology; D007601:Jugular Veins; D008297:Male; D011859:Radiography; D012851:Sinus Thrombosis, Intracranial / Q000000981:diagnostic imaging / Q000188:drug therapy*; D012865:Skiing; D012887:Skull Fractures / Q000150:complications*; D013702:Temporal Lobe / Q000293:injuries*; D015912:Thrombolytic Therapy; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use*
D000925:Anticoagulants; D005343:Fibrinolytic Agents; D006493:Heparin; D014568:Urokinase-Type Plasminogen Activator