Three Cases of Dural Sinus Thrombosis Treated with Direct Thrombolysis Using Tissue Plasminogen Activator(t-PA)

ABSTRACT

Background and Objective : Dural sinus thrombosis(DST) is a rare disorder with many etiologies and unpredictable clinical courses. The optimal mode of treatment has not been well established. With the advent of neuroradiological intervention, we have successfully performed the direct infusion of t-PA into the venous sinus for the prompt Iysis of thrombosis and subsequent clinical Improvement. METHODS: Three patients, presented with headache, vomiting or focal neurological deficits, were diagnosed as having dural sinus thrombosis by MRI. After the confirmation by angiogram with a superselective transfemoral catheter, a bolus of t-PA was injected into the thrombosed portion of the dural sinuses, followed by a continuous t-PA infusion at a rate of 40mg/hr. Result : All three patients were clinically improved. Follow-up angiogram on the next day demonstrated recanalization of the thromboses venous sinus. Two patients developed non-life threatening extracranial hemorrhage as a complication. Conclusion : Authors suggest that direct thrombolysis with t-PA is a very effective method of treatment in the early phase of DST. Further study is needed to decide the appropriate t-PA dosage to minimize the complication.