Local thrombolysis for severe cerebral venous sinus thrombosis

Cerebral venous thrombosis is a rare entity that can be difficult to manage. Most patients with cerebral sinus thrombosis recover after treatment with heparin, but a subgroup of severe cerebral venous sinus thrombosis has a poor prognosis. Those patients may benefit from intrasinus thrombolysis. The purpose of this research was to carry out a retrospective analysis of patients with severe cerebral venous sinus thrombosis, and to study the safety and efficacy of intrasinus thrombolysis in patients with cerebral venous sinus thrombosis unresponsive to conventional heparin therapy.

Thirty-seven patients with cerebral venous sinus thrombosis who received intrasinus thrombolysis during a 3-year period (January 2007 to December 2009) were included in this study. Urokinase was infused into the sinus via a microcatheter. Data regarding demographic, clinical, and radiologic features were collected. Follow-up data were obtained at 6 months. MRV was repeated to assess the recanalization of the venous sinus.

Twenty-seven patients (73%) had good outcome and 7 patients (19%) who were independent for activities of daily life had only mild deficits. One patient survived with severe neurologic deficits and 2 patients died. Complete recanalization of the superior sagittal sinus was seen in 35 patients (97%). At a follow-up of 6 months, 34 patients (92%) were either asymptomatic or had only minor subjective symptoms.

Intrasinus thrombolysis is safe and effective in patients with severe cerebral venous sinus thrombosis. However, the subgroup of patients that is likely to benefit the most from this procedure is not clear from our data. Large randomized controlled trials are required to further clarify this issue.