Septic cavernous sinus thrombosis secondary to acute bacterial sinusitis: A retrospective study of seven cases
Septic cavernous sinus thrombosis secondary to acute bacterial sinusitis: A retrospective study of seven cases
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DOI：
10.2500/ajra.2015.29.4127
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发表时间：
2015-01-01
影响因子：
2.6
通讯作者：
Herman, Philippe
中科院分区：
文献类型：
--
作者：
Lize, Franklin;Verillaud, Benjamin;Herman, Philippe
背景：感染性海绵窦血栓形成(SCST)是一种罕见但严重的急性细菌性鼻窦炎并发症。由于缺乏最新的研究，影像技术以及内外科治疗的进展受到阻碍。目的：报告过去10年来在急性细菌性蝶窦炎患者中进行SCST治疗的经验，并讨论最初的工作和治疗策略。方法：我们对2003-2013年间在三级护理中心收治的与急性鼻窦炎相关的SCST患者进行了回顾性研究。回顾临床图表，包括人口统计学、临床表现、影像和微生物学表现、内科和外科治疗以及结果。结果：7名患者接受了SCST治疗。所有病例均累及蝶窦。最常见的症状包括头痛(100%)、脑神经损害(86%)、发热(71%)和眼眶症状(71%)。所有病例均经脑部增强CT扫描确诊。4名患者(57%)有额外的颅内并发症。从临床到诊断的平均时间为13.7天。所有患者均接受大剂量静脉滴注治疗。抗生素、抗凝治疗和鼻内窥镜手术引流感染的鼻窦。这种治疗策略的死亡率为0%，但7名患者中有4名出现了一过性或永久性的神经功能障碍，包括1名永久性单侧视力丧失。抗生素、抗凝治疗和鼻内窥镜下感染的鼻窦引流是治疗SCST的有效策略，但长期后遗症仍然很常见。
Background: Septic cavernous sinus thrombosis (SCST) is a rare but severe complication of acute bacterial sinusitis. Evaluations of advances in imaging techniques as well as in medical and surgical treatment are hampered by the lack of recent studies.Objective: We aim to report our experience in the management of SCST in patients with acute bacterial sphenoid sinusitis over the past 10 years and to discuss the initial work-up and treatment strategies.Methods: We performed a retrospective study of patients admitted for SCST related to acute sinusitis at a tertiary care center between 2003 and 2013. Clinical charts were reviewed for demographics, clinical presentations, imaging and microbiologic findings, medical and surgical treatments, and outcomes.Results: Seven patients were treated for SCST. Sphenoid sinus was involved in all cases. The most frequent presenting signs included headache (100%), cranial nerve impairment (86%), fever (71%), and orbital symptoms (71%). Diagnosis was confirmed by a cerebral contrast-enhanced CT scan in all cases. Four patients (57%) had an additional intracranial complication. The average time between clinical onset and diagnosis was 13.7 days. All patients were treated by high-dose i.v. antibiotics, anticoagulation therapy, and surgical endoscopic drainage of the infected sinuses. This treatment strategy resulted in a mortality rate of 0%, but four out of the seven patients developed transient or permanent neurologic deficits, including one with permanent unilateral visual loss.Conclusion: The combination of high-dose i.v. antibiotics, anticoagulation therapy, and endoscopic drainage of the infected paranasal sinus is an effective strategy for the treatment of SCST, but long-term sequelae remain frequent.