Postoperative dural sinus thrombosis in a patient in a hypercoagulable state

Case report

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  • 1 Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
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✓ Spontaneous cerebral venous sinus thrombosis is a rare problem that may be encountered in patients with underlying thrombophilic disorders. It has also been reported as a postoperative complication following suboccipital, transpetrosal, and transcallosal approaches. The authors report on a 67-year-old man with two prior episodes of lower-extremity deep venous thrombosis who underwent transcallosal resection of a colloid cyst and in whom sagittal sinus thrombosis developed 2 weeks thereafter. Results of a subsequent hematological workup revealed both a factor V Leiden mutation and the presence of antiphospholipid antibodies, two thrombophilic risk factors that likely contributed to the development of delayed postoperative sinus thrombosis. Although the safety of low-molecular-weight heparin (LMWH) after craniotomy has not been established in a randomized, controlled study, there is sufficient evidence to justify its use for prophylactic anticoagulation therapy in patients at high risk for postoperative cerebral venous thrombosis. The authors propose using LMWH prophylaxis in patients with thrombophilic disorders who undergo neurosurgical procedures in proximity to dural sinuses in an effort to prevent catastrophic venous infarction.

Abbreviations used in this paper:

aplAb = antiphospholipid antibody; CT = computed tomography; CVT = cerebral venous thrombosis; DVT = deep venous thrombosis; IVCF = inferior vena cava filter; LMWH = low-molecular-weight heparin; MR = magnetic resonance; SST = sagittal sinus thrombosis.

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  • 1

    Agnelli G, , Piovella F, , Buoncristiani P, , Severi P, , Pini M, & D’Angelo A, et al.: Enoxaparin plus compression stockings compared with compression stockings alone in the prevention of venous thromboembolism after elective neurosurgery. N Engl J Med 339:8085, 1998

    • Search Google Scholar
    • Export Citation
  • 2

    Apuzzo ML, , Chikovani OK, , Gott PS, , Teng EL, , Zee CS, & Giannotta SL, et al.: Transcallosal, interfornicial approaches for lesions affecting the third ventricle: surgical considerations and consequences. Neurosurgery 10:547554, 1982

    • Search Google Scholar
    • Export Citation
  • 3

    Bellotti C, , Pappada G, , Sani R, , Oliveri G, & Stangalino C: The trans-callosal approach for lesions affecting the lateral and third ventricles. Surgical considerations and results in a series of 42 cases. Acta Neurochir (Wien) 111:103107, 1991

    • Search Google Scholar
    • Export Citation
  • 4

    Desai KI, , Nadkarni TD, , Muzumdar DP, & Goel AH: Surgical management of colloid cyst of the third ventricle—a study of 105 cases. Surg Neurol 57:295304, 2002

    • Search Google Scholar
    • Export Citation
  • 5

    Deschiens MA, , Conard J, , Horellou MH, , Ameri A, , Preter M, & Chedru F, et al.: Coagulation studies, factor V Leiden, and anticardiolipin antibodies in 40 cases of cerebral venous thrombosis. Stroke 27:17241730, 1996

    • Search Google Scholar
    • Export Citation
  • 6

    Garrido E, & Fahs GR: Cerebral venous and sagittal sinus thrombosis after transcallosal removal of a colloid cyst of the third ventricle: case report. Neurosurgery 26:540542, 1990

    • Search Google Scholar
    • Export Citation
  • 7

    Gerlach R, , Scheuer T, , Beck J, , Woszczyk A, , Seifert V, & Raabe A: Risk of postoperative hemorrhage after intracranial surgery after early nadroparin administration: results of a prospective study. Neurosurgery 53:10281035, 2003

    • Search Google Scholar
    • Export Citation
  • 8

    Hamilton MG, , Hull RD, & Pineo GF: Venous thromboembolism in neurosurgery and neurology patients: a review. Neurosurgery 34:280296, 1994

    • Search Google Scholar
    • Export Citation
  • 9

    Keiper GL Jr, , Sherman JD, , Tomsick TA, & Tew JM Jr: Dural sinus thrombosis and pseudotumor cerebri: unexpected complications of suboccipital craniotomy and translabyrinthine craniectomy. J Neurosurg 91:192197, 1999

    • Search Google Scholar
    • Export Citation
  • 10

    Kelly J, , Hunt BJ, , Lewis RR, & Rudd A: Anticoagulation or inferior vena cava filter placement for patients with primary intracerebral hemorrhage developing venous thromboembolism?. Stroke 34:29993005, 2003

    • Search Google Scholar
    • Export Citation
  • 11

    Kyrle PA, , Minar E, , Bialonczyk C, , Hirschl M, , Weltermann A, & Eichinger S: The risk of recurrent venous thromboembolism in men and women. N Engl J Med 350:25582563, 2004

    • Search Google Scholar
    • Export Citation
  • 12

    Ludemann P, , Nabavi DG, , Junker R, , Wolff E, , Papke K, & Buchner H, et al.: Factor V Leiden mutation is a risk factor for cerebral venous thrombosis: a case-control study of 55 patients. Stroke 29:25072510, 1998

    • Search Google Scholar
    • Export Citation
  • 13

    Macdonald RL, , Amidei C, , Baron J, , Weir B, , Erickson RK, & Hekmatpanah J, et al.: Randomized, pilot study of intermittent pneumatic compression devices plus dalteparin versus intermittent pneumatic compression devices plus heparin for prevention of venous thromboembolism in patients undergoing craniotomy. Surg Neurol 59:363374, 2003

    • Search Google Scholar
    • Export Citation
  • 14

    Macdonald RL, , Amidei C, , Lin G, , Munshi I, , Baron J, & Weir BK, et al.: Safety of perioperative subcutaneous heparin for prophylaxis of venous thromboembolism in patients undergoing craniotomy. Neurosurgery 45:245252, 1999

    • Search Google Scholar
    • Export Citation
  • 15

    Martinelli I, , Landi G, , Merati G, , Cella R, , Tosetto A, & Mannucci PM: Factor V gene mutation is a risk factor for cerebral venous thrombosis. Thromb Haemost 75:393394, 1996

    • Search Google Scholar
    • Export Citation
  • 16

    Ohata K, , Haque M, , Morino M, , Nagai K, , Nishio A, & Nishijima Y, et al.: Occlusion of the sigmoid sinus after surgery via the presigmoidal-transpetrosal approach. J Neurosurg 89:575584, 1998

    • Search Google Scholar
    • Export Citation
  • 17

    Rosenstingl S, , Ruivard M, , Melon E, , Schaeffer A, & Gouault-Heilmann M: [Cerebral-vein thrombosis: retrospective study of twenty seven cases]. Rev Med Interne 23:973982, 2002. (Fr)

    • Search Google Scholar
    • Export Citation
  • 18

    Sasaki T, , Hoya K, , Kinone K, & Kirino T: Postsurgical development of dural arteriovenous malformations after transpetrosal and transtentorial operations: case report. Neurosurgery 37:820825, 1995

    • Search Google Scholar
    • Export Citation
  • 19

    Yassari R, , Jahromi B, & Macdonald R: Dural arteriovenous fistula after craniotomy for pilocytic astrocytoma in a patient with protein S deficiency. Surg Neurol 58:5964, 2002

    • Search Google Scholar
    • Export Citation
  • 20

    Zuber M, , Toulon P, , Marnet L, & Mas JL: Factor V Leiden mutation in cerebral venous thrombosis. Stroke 27:17211723, 1996

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