Treatment of dural sinus thrombosis using selective catheterization and urokinase

Authors

  • Dr Michael Horowitz MD,

    Corresponding author
    1. Department of Radiology, Division of Neuroradiology, The University of Texas Southwestern medical Center at Dallas, Dallas
    2. Department of Neurological Surgery, The University of Texas Southwestern medical Center at Dallas, Dallas
    • Department of Radiology, Division of Neuroradiology, The University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, Dallas, TX 75235-8896
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  • Phillip Purdy MD,

    1. Department of Radiology, Division of Neuroradiology, The University of Texas Southwestern medical Center at Dallas, Dallas
    2. Department of Neurology, The University of Texas Southwestern Medical Center at Dallas, Dallas
    3. Department of Neurological Surgery, The University of Texas Southwestern medical Center at Dallas, Dallas
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  • Hal Unwin MD,

    1. Department of Neurology, The University of Texas Southwestern Medical Center at Dallas, Dallas
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  • George Carstens III MD,

    1. Department of Radiology, Division of Neuroradiology, The University of Texas Southwestern medical Center at Dallas, Dallas
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  • Ralph Greenlee MD,

    1. Department of Neurological Surgery, The University of Texas Southwestern medical Center at Dallas, Dallas
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  • Joe Hise MD,

    1. Department of Radiology, The Scott and White Clinic, Temple, TX
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  • Tom Kopitnik MD,

    1. Department of Neurological Surgery, The University of Texas Southwestern medical Center at Dallas, Dallas
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  • Hunt Batjer MD,

    1. Department of Neurological Surgery, The University of Texas Southwestern medical Center at Dallas, Dallas
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  • Nancy Rollins MD,

    1. Department of Radiology, Children's Hospital of Dallas, Dallas
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  • Duke Samson MD

    1. Department of Neurological Surgery, The University of Texas Southwestern medical Center at Dallas, Dallas
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Abstract

Thrombosis of the cerebral dural venous sinuses, cortical draining veins, and deep cerebral veins is a rare clinical finding. Because of its low incidence and multiple etiologies, the optimum therapy for this condition will only be elucidated by a multicenter, randomized prospective study. At our institution, we favor early and aggressive management of cerebral venous sinus thrombosis with transfemoral, venous intradural infusions of the fibrinolytic agent urokinase. To date, treatment of only 13 patients using this technique has been reported in the English literature. This report adds 12 more such treated patients. Despite the presence of preinfusion infarcts in 5 patients, four of which were hemorrhagic, we incurred no major therapeutic morbidity. Functional sinus patency was achieved in 11 of 12 patients, with our only true failure occurring in an individual with symptoms of at least 2 months' duration. Good to excellent clinical outcome was achieved in 10 of 11 patients (one newborn had inadequate follow-up).

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