Cerebral venous sinus thrombosis during superselective intra-arterial infusion of cisplatin and concomitant radiotherapy for maxillary squamous cell carcinoma
Cerebral venous sinus thrombosis during superselective intra-arterial infusion of cisplatin and concomitant radiotherapy for maxillary squamous cell carcinoma
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上颌鳞状细胞癌超选择性动脉内灌注顺铂联合放疗期间脑静脉窦血栓形成
DOI：
10.1136/bcr-2017-220591
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发表时间：
2017
期刊：
影响因子：
--
通讯作者：
Yamasoba Tatsuya
中科院分区：
文献类型：
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作者：
Okamura Shun;Saito Yuki;Mori Harushi;Yamasoba Tatsuya
一名67岁男子因鼻出血转介至我科。CT显示肿块破坏了左侧副鼻窦的后骨壁。组织病理学检查为上颌窦鳞状细胞癌，临床分期为T4aN0M0。MRI未见脑血管血栓形成。最初计划的治疗包括7个疗程，每周一次顺铂（100 mg/ m2）动脉内输注（IA），硫代硫酸钠静脉解毒，并伴有放射治疗（RT）（总剂量70 Gy）。1 CT血管造影显示上颌和面部动脉为肿瘤供血。四个疗程的IA后，进行MRI和CT（图1A）进行中期评估。虽然肿瘤大小明显缩小，但左侧横乙状窦出现脑静脉血栓，血流中断，无皮质静脉回流或脑水肿（图1B和C）。由于患者没有表现出神经功能障碍的迹象，因此按照计划继续使用肝素抗凝治疗。2
A 67-year-old man was referred to our department because of epistaxis. CT demonstrated that a mass had destroyed the posterior bony wall of the left paranasal sinus. Histopathological examination revealed squamous cell carcinoma of the maxillary sinus, and clinically staged T4aN0M0 was diagnosed. MRI showed no thrombus in the brain blood vessels.The initially planned treatment consisted of seven courses of intra-arterial infusion (IA) of weekly cisplatin (100 mg/m 2) with intravenous detoxification by sodium thiosulfate and concomitant radiotherapy (RT)(total 70 Gy). 1 CT angiography revealed that the maxillary and facial arteries were feeding the tumour. After four courses of IA, MRI and CT (figure 1A) were performed for an interim evaluation. Although the size of the tumour was significantly reduced, cerebral venous thrombus was present in the left transverse sigmoid sinus and interrupted the blood flow without cortical venous reflux or brain oedema (figure 1B and C). Because the patient showed no signs of neurological deficits, treatment was continued, as planned, with heparin anticoagulation. 2