Postoperative cerebral venous sinus thrombosis in the setting of surgery adjacent to the major dural venous sinuses

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OBJECTIVE

Cerebral venous sinus thrombosis (CVST) is a known complication of surgeries near the major dural venous sinuses. While the majority of CVSTs are asymptomatic, severe sinus thromboses can have devastating consequences. The objective of this study was to prospectively evaluate the true incidence and risk factors associated with postoperative CVST and comment on management strategies.

METHODS

A prospective study of 74 patients who underwent a retrosigmoid, translabyrinthine, or suboccipital approach for posterior fossa tumors, or a supratentorial craniotomy for parasagittal/falcine tumors, was performed. All patients underwent pre- and postoperative imaging to evaluate sinus patency. Demographic, clinical, and operative data were collected. Statistical analysis was performed to identify incidence and risk factors.

RESULTS

Twenty-four (32.4%) of 74 patients had postoperative MR venograms confirming CVST, and all were asymptomatic. No risk factors, including age (p = 0.352), BMI (p = 0.454), sex (p = 0.955), surgical approach (p = 0.909), length of surgery (p = 0.785), fluid balance (p = 0.943), mannitol use (p = 0.136), tumor type (p = 0.46, p = 0.321), or extent of resection (p = 0.253), were statistically correlated with thrombosis. All patients were treated conservatively, with only 1 patient receiving intravenous fluids. There were no instances of venous infarctions, hemorrhages, or neurological deficits. The rate of CSF leakage was significantly higher in the thrombosis group than in the nonthrombosis group (p = 0.01).

CONCLUSIONS

This prospective study shows that the radiographic incidence of postoperative CVST is higher than that previously reported in retrospective studies. In the absence of symptoms, these thromboses can be treated conservatively. While no risk factors were identified, there may be an association between postoperative CVST and CSF leak.

ABBREVIATIONS CTV = CT venography; CVST = cerebral venous sinus thrombosis; MRV = MR venography.

Article Information

Correspondence Donato Pacione: NYU Langone Medical Center, New York, NY. donato.pacione@nyumc.org.

INCLUDE WHEN CITING Published online October 26, 2018; DOI: 10.3171/2018.4.JNS18308.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

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Figures

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    Noncontrast CT scan of the head, demonstrating a tubular hyperdensity (arrow) that contours the shape of the distal right transverse and sigmoid sinuses and is suggestive of sinus thrombosis. This is referred to as the “cord sign.” Figure is available in color online only.

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    Axial MR venogram after contrast administration, revealing a filling defect in the right transverse sigmoid junction (arrow), indicating a venous thrombosis. This patient was noted to have a thrombosis in the right transverse sinus just to the right to the midline, extending through the right sigmoid sinus, right jugular bulb, and into the proximal right internal jugular vein just below the skull base. Figure is available in color online only.

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    Left: Coronal MR venogram after contrast administration, revealing venous thrombosis of the right transverse and sigmoid sinuses, right jugular bulb, and into the proximal right internal jugular vein just below the skull base. Right: Coronal MR venogram after contrast administration revealing interval resolution of sinus thrombosis at 4 months.

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