title: Endovascular treatment of children with cerebral venous sinus thrombosis: a case series.
abstract: BACKGROUND
  Cerebral venous sinus thrombosis is a potentially serious condition affecting 0.56 to 0.67 per 100,000 children annually; adverse outcomes are common. The standard of care is anticoagulation with heparin. A proportion of patients, however, remain in a severe clinical condition and in these, endovascular therapy is an alternative treatment. There is little published literature on the use of endovascular treatments in children with cerebral venous sinus thrombosis.
  
  
  METHODS
  We retrospectively reviewed case notes and imaging in a consecutive series of nine children treated using endovascular therapy after diagnosis of cerebral venous sinus thrombosis. Clinical presentation, decision to escalate therapy, methods of recanalization, and clinical outcome were assessed.
  
  
  RESULTS
  Nine children were treated (age range 18 months to 16 years). Diagnosis was made by computed tomography, computed tomography venography, magnetic resonance imaging, or magnetic resonance venography. Seven children were in a coma; one had signs of raised intracranial pressure with progressive cranial nerve palsies; and one was drowsy with a fluctuating hemiparesis. Eight children had been treated with heparin without improvement. Several endovascular methods were used including local tissue plasminogen activator, microguidewire and catheter disruption, balloon angioplasty, and thromboaspiration using the Penumbra device. Eight children had good functional outcomes. One child died as a result of uncontrolled intracranial hypertension secondary to cerebral venous sinus thrombosis.
  
  
  CONCLUSIONS
  Endovascular therapy may have a role in the treatment of cerebral venous sinus thrombosis in children when medical therapy has failed and the patient is in a poor clinical condition.
authors.affiliation: Department of Neuroradiology, Frenchay Hospital, Bristol, United Kingdom. Electronic address: alex_mortimer@hotmail.com.
authors.forename: Alex M
authors.initials: AM
authors.lastname: Mortimer
authors.forename: Marcus D
authors.initials: MD
authors.lastname: Bradley
authors.forename: Suzanne
authors.initials: S
authors.lastname: O'Leary
authors.forename: Shelley A
authors.initials: SA
authors.lastname: Renowden
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D012851:Sinus Thrombosis, Intracranial / Q000175:diagnosis / Q000628:therapy*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D015898:Tomography Scanners, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D010959:Tissue Plasminogen Activator
keywords: cerebral venous sinus; endovascular; thrombectomy; thromboaspiration; thrombolysis; thrombosis