Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Mechanical Thrombectomy for Refractory Cerebral Venous Sinus Thrombosis in a Child with Nephrotic Syndrome : A Case Report

  • Jing Ye (Department of Neurology, The Sixth People's Hospital of Chengdu) ;
  • Yuan Yang (Department of Neurology, Affiliated Hospital of Southwest Medical University) ;
  • Weifeng Wan (Department of Neurosurgery, Affiliated Hospital of Southwest Medical University) ;
  • Xuntai Ma (Department of Neurology, The First Affiliated Hospital of Chengdu Medical College) ;
  • Lei Liu (Department of Neurology, The First Affiliated Hospital of Chengdu Medical College) ;
  • Yong Liu (Department of Neurology, The First Affiliated Hospital of Chengdu Medical College) ;
  • Zhongchun He (Department of Neurology, The First Affiliated Hospital of Chengdu Medical College) ;
  • Zhengzhou Yuan (Department of Neurology, Affiliated Hospital of Southwest Medical University)
  • Received : 2022.11.25
  • Accepted : 2023.03.13
  • Published : 2023.11.01
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Abstract

Nephrotic syndrome (NS) is associated with cerebral venous sinus thrombosis (CVST), which is a rare cerebrovascular disorder in children. Systemic anticoagulation with heparin is the standard therapy for CVST, and mechanical thrombectomy (MT) has been described as a salvage treatment for adult anticoagulant refractory CVST, However, it has never been reported in children. We describe a case of MT for refractory CVST in a child with NS. A 13-year-old boy with newly diagnosed NS presented to an emergency department with acute headache. A head computed tomography showed acute thrombus in the superior sagittal sinus, straight sinus and transverse sinus. The child was started on heparin therapy, but clinically deteriorated and became unresponsive. In view of the rapid deterioration of the condition after anticoagulation treatment, the patient received intravascular treatment. Several endovascular technologies, such as stent retriever and large bore suction catheter have been adopted. After endovascular treatment, the patient's neurological condition was improved within 24 hours, and magnetic resonance venography of the head demonstrated that the CVST was reduced. The child recovered with normal neurological function at discharge. This case highlights the importance of considering MT for refractory CVST, and we suggest that MT may be considered for refractory CVST with NS in children.

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References

  1. Behrouzi R, Punter M : Diagnosis and management of cerebral venous thrombosis. Clin Med (Lond) 18 : 75-79, 2018 https://doi.org/10.7861/clinmedicine.18-1-75
  2. Capecchi M, Abbattista M, Martinelli I : Cerebral venous sinus thrombosis. J Thromb Haemost 16 : 1918-1931, 2018 https://doi.org/10.1111/jth.14210
  3. Dandapat S, Samaniego EA, Szeder V, Siddiqui FM, Duckwiler GR, Kiddy U, et al. : Safety and efficacy of the use of large bore intermediate suction catheters alone or in combination for the treatment of acute cerebral venous sinus thrombosis: a multicenter experience. Interv Neuroradiol 26 : 26-32, 2020
  4. Ferriero DM, Fullerton HJ, Bernard TJ, Billinghurst L, Daniels SR, DeBaun MR, et al. : Management of stroke in neonates and children: a scientific statement from the American Heart Association/American Stroke Association. Stroke 50 : e51-e96, 2019
  5. Feske SK : Ischemic stroke. Am J Med 134 : 1457-1464, 2021 https://doi.org/10.1016/j.amjmed.2021.07.027
  6. Gadgil N, Aldave G, Whitehead WE, Dmytriw AA, Chen K, Orbach D, et al. : Endovascular intervention for refractory pediatric cerebral venous sinus thrombosis. Pediatr Neurol 121 : 45-50, 2021 https://doi.org/10.1016/j.pediatrneurol.2021.05.004
  7. Gao X, Liu Y, He Q, Shen X : Cerebral venous sinus thrombosis in nephrotic syndrome. Kidney Int 101 : 1303, 2022
  8. Liu S, Shan XG, Zhang XJ : The place of hydration using intravenous fluid in patients at risk of developing contrast-associated nephropathy. Br J Hosp Med (Lond) 81 : 1-7, 2020 https://doi.org/10.12968/hmed.2020.0394
  9. Mortimer AM, Bradley MD, O'Leary S, Renowden SA : Endovascular treatment of children with cerebral venous sinus thrombosis: a case series. Pediatr Neurol 49 : 305-312, 2013 https://doi.org/10.1016/j.pediatrneurol.2013.07.008
  10. Ropper AH, Klein JP : Cerebral venous thrombosis. N Engl J Med 385 : 59-64, 2021 https://doi.org/10.1056/NEJMra2106545
  11. Sebire G, Tabarki B, Saunders DE, Leroy I, Liesner R, Saint-Martin C, et al. : Cerebral venous sinus thrombosis in children: risk factors, presentation, diagnosis and outcome. Brain 128 : 477-489, 2005 https://doi.org/10.1093/brain/awh412
  12. Siddiqui FM, Dandapat S, Banerjee C, Zuurbier SM, Johnson M, Stam J, et al. : Mechanical thrombectomy in cerebral venous thrombosis: systematic review of 185 cases. Stroke 46 : 1263-1268, 2015 https://doi.org/10.1161/STROKEAHA.114.007465
  13. Stam J : Thrombosis of the cerebral veins and sinuses. N Engl J Med 352 : 1791-1798, 2005 https://doi.org/10.1056/NEJMra042354
  14. Tavil B, Kara F, Topaloglu R, Aytac S, Unal S, Kuskonmaz B, et al. : Case series of thromboembolic complications in childhood nephrotic syndrome: Hacettepe experience. Clin Exp Nephrol 19 : 506-513, 2015 https://doi.org/10.1007/s10157-014-1005-y
  15. Yun JH, Ko JH, Lee MJ : Early spontaneous recanalization of sigmoid sinus thrombosis following a closed head injury in a pediatric patient : a case report and review of literature. J Korean Neurosurg Soc 58 : 150-154, 2015 https://doi.org/10.3340/jkns.2015.58.2.150