Extensive dural sinus thrombosis treated by surgical removal and local streptokinase infusion

This article describes the clinical course, including measurements of intracranial pressure (ICP), radiological findings, and treatment, of a gravely ill patient with extensive thrombosis involving the superior sagittal and both transverse sinuses, and the galenic venous system. When "conventional" therapy including anticoagulants and neuro-intensive care failed to reverse the progressive neurological deterioration or to control the ICP, the condition was approached surgically and thrombotic material was removed from the dural sinuses without much difficulty. The effect on the ICP was dramatic, although short-lived. A second operation, combined with local infusion of streptokinase in the sagittal sinus, had a permanent effect as judged from the ICP measurements, radiological findings, and clinical improvement. The combination of direct operative removal of thrombotic material and local infusion of a thrombolytic agent (streptokinase) proved to be an effective treatment of severe dural sinus thrombosis in this patient.