乙状窦后开颅术后静脉窦狭窄：系统综述与示例病例。

文献信息

中文摘要

引言： 后颅窝开颅术后的脑静脉窦并发症日益受到认识，但仍未得到充分描述。尽管大多数病例无症状，但静脉流出受损可能导致颅内高压。本工作系统综述了后颅窝手术后脑静脉窦并发症的现有证据，包括其管理；此外，我们报告一例采用血管内静脉窦支架置入术治疗术后静脉窦狭窄的示例病例。
方法： 我们按照系统综述和荟萃分析首选报告项目（PRISMA）指南，使用PubMed、Embase和SCOPUS数据库进行了系统综述，以识别和描述后颅窝手术后的脑静脉窦相关并发症。此外，我们报告一例示例病例。
结果： 共纳入33项研究，包含4,893例患者。在4,237例患者中报告了429例脑静脉窦血栓形成（10.1%），而在专门评估狭窄的研究中，784例患者中识别出135例脑静脉窦狭窄（17.2%）。术中静脉窦损伤发生在1,618例患者中的55例（3.4%）。仅16例患者接受了血管内治疗，其中13例接受了静脉窦支架置入术。我们的示例病例为一名28岁女性，在乙状窦后前庭神经鞘瘤切除术后继发严重术后横窦-乙状窦狭窄并出现颅内高压。静脉测压显示存在显著的跨狭窄压力梯度，成功的血管内支架置入术恢复了静脉流出，并在12个月随访时支架保持通畅且临床稳定。
结论： 后颅窝手术后的静脉窦并发症可能被低估，尽管具有临床意义的静脉流出梗阻仍不常见。本系统综述强调了关于术后静脉窦狭窄及其血管内管理的证据有限。对于经过仔细选择的具有血流动力学意义的术后狭窄患者，静脉窦支架置入术可能是一种有前景的治疗选择；然而，需要更大规模的前瞻性研究，采用标准化诊断标准和长期随访，以更好地确定其作用。

英文摘要

INTRODUCTION: Postoperative cerebral venous sinus complications in posterior fossa craniotomies are increasingly recognized but remain incompletely characterized. Although most cases are asymptomatic, impaired venous outflow may lead to intracranial hypertension. This work systematically reviews the available evidence on postoperative cerebral venous sinus complications following posterior fossa surgery, including its management; additionally, we present an illustrative case of postoperative venous sinus stenosis treated with endovascular venous sinus stenting.
METHODS: We conducted a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses PRIMA guidelines using PubMed, Embase, and SCOPUS databases to identify and characterize cerebral venous sinus-related complications following posterior fossa surgery. Additionally, we present an illustrative case.
RESULTS: Thirty-three studies comprising 4,893 patients were included. CVST was reported in 429 of 4,237 patients (10.1%), whereas CVSS was identified in 135 of 784 patients (17.2%) from studies specifically evaluating stenosis. Intraoperative venous sinus injury occurred in 55 of 1,618 patients (3.4%). Only 16 patients underwent endovascular treatment, of whom 13 received venous sinus stenting. Our illustrative case involved a 28-year-old woman who developed intracranial hypertension secondary to severe postoperative transverse-sigmoid sinus stenosis following retrosigmoid vestibular schwannoma resection. Venous manometry demonstrated a significant trans-stenotic pressure gradient, and successful endovascular stenting restored venous outflow with sustained stent patency and clinical stability at 12-month follow-up.
CONCLUSIONS: Postoperative venous sinus complications following posterior fossa surgery are likely underrecognized, although clinically significant venous outflow obstruction remains uncommon. This systematic review highlights the limited evidence regarding postoperative venous sinus stenosis and its endovascular management. Venous sinus stenting may represent a promising treatment option in carefully selected patients with hemodynamically significant postoperative stenosis; however, larger prospective studies with standardized diagnostic criteria and long-term follow-up are needed to better define its role.