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Kaufmann MR, Camilon PR, Levi JR, Devaiah AK. Predicting Anticoagulation Need for Otogenic Intracranial Sinus Thrombosis: A Machine Learning Approach. J Neurol Surg B Skull Base 2020; 82:233-243. [PMID: 33777638 DOI: 10.1055/s-0040-1713105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 04/15/2020] [Indexed: 10/23/2022] Open
Abstract
Objective The role of anticoagulation (AC) in the management of otogenic cerebral venous sinus thrombosis (OCVST) remains controversial. Our study aims to better define when AC is used in OCVST. Methods MEDLINE, EMBASE, and The Cochrane Library were searched from inception to February 14, 2019 for English and English-translated articles. References cited in publications meeting search criteria were searched. Titles and abstracts were screened and identified in the literature search, assessing baseline risk of bias on extracted data with the methodological index for nonrandomized studies (MINORS) scale. Random effects meta-regression followed by random forest machine learning analysis across 16 moderator variables between AC and nonanticoagulated (NAC) cohorts was conducted. Results A total of 92% of treated patients were free of neurologic symptoms at the last follow-up (mean 29.64 months). Four percent of AC and 14% of NAC patients remained symptomatic (mean 18.72 and 47.10 months). 3.5% of AC patients experienced postoperative wound hematomas. AC and NAC recanalization rates were 81% (34/42) and 63% (five-eights), respectively. OCVST was correlated with cholesteatoma and intracranial abscess. Among the analyzed covariates, intracranial abscess was most predictive of AC and cholesteatoma was most predictive of NAC. Comorbid intracranial abscess and cholesteatoma were predictive of AC. Conclusion The present study is the first to utilize machine learning algorithms in approaching OCVST. Our findings support the therapeutic use of AC in the management of OCVST when complicated by thrombophilia, intracranial abscess, and cholesteatoma. Patients with intracranial abscess and cholesteatoma may benefit from AC and surgery. Patients with cholesteatoma can be managed with NAC and surgery.
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Affiliation(s)
- Matthew R Kaufmann
- Boston University School of Medicine, Boston, Massachusetts, United States
| | - Philip Ryan Camilon
- Boston University School of Medicine, Boston, Massachusetts, United States.,Department of Otolaryngology, Boston University, Boston, Massachusetts, United States
| | - Jessica R Levi
- Boston University School of Medicine, Boston, Massachusetts, United States.,Department of Otolaryngology, Boston University, Boston, Massachusetts, United States
| | - Anand K Devaiah
- Boston University School of Medicine, Boston, Massachusetts, United States.,Department of Otolaryngology, Boston University, Boston, Massachusetts, United States.,Department of Neurological Surgery and Ophthalmology, Boston, Massachusetts, United States.,Institute for Health System Innovation and Policy, Boston University, Boston, Massachusetts, United States
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2
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Wong BYW, Hickman S, Richards M, Jassar P, Wilson T. Management of paediatric otogenic cerebral venous sinus thrombosis: a systematic review. Clin Otolaryngol 2016; 40:704-14. [PMID: 26769686 DOI: 10.1111/coa.12504] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND Otogenic paediatric cerebral venous sinus thrombosis (CVST) is rare but has potential clinical sequelae. Its management has long been debated mainly concerning the role of surgery and the use of anticoagulant therapy. OBJECTIVE OF REVIEW To review the current literature and examine the medical and surgical management of paediatric otogenic CVST and its clinical and radiological outcome. TYPE OF REVIEW Systematic review. SEARCH STRATEGY The electronic databases (MEDLINE, EMBASE, Cochrane) were searched from inception to November 2014 using text words 'cerebral venous sinus thrombosis OR cerebral venous thrombosis OR lateral sinus thrombosis OR sigmoid sinus thrombosis' AND 'otogenic OR mastoiditis OR otitis media' AND 'children OR paediatric OR pediatric'. EVALUATION METHOD Inclusion criteria were applied by two reviewers and data extraction was carried out. The type of otological surgery (conservative versus extensive) and the use of anticoagulants with their clinical and radiological outcomes were tabulated. RESULTS Thirty-six studies (15 case reports and 21 case series) were included with a total of 190 patients. A total of 92.1% of patients underwent otological surgery, and 69.5% had conservative surgery and 30.5% extensive otological surgery. Anticoagulants were used in 59%. A total of 79.2% of patients were reported to have had a good clinical outcome. Within this group, 56% had conservative surgery and anticoagulants. Follow-up scans were documented in 61.6% of patients and complete recanalisation was observed in 51%. Complete recanalisation was observed in 47% of those who had been anticoagulated and 55% of those who received no anticoagulation. CONCLUSIONS Conservative otological surgery with the combination of anticoagulation was the most common treatment modality found in the group of patients with good clinical outcome. However, given the current low level of evidence, a multicentre collaborative study is needed to help establish the optimum surgical approach and the role of anticoagulation in managing paediatric otogenic CVST.
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Affiliation(s)
- B Y W Wong
- Department of ENT, Pinderfields General Hospital, Wakefield, UK
| | - S Hickman
- Department of ENT, Pinderfields General Hospital, Wakefield, UK
| | - M Richards
- Department of Paediatric Haematology, Leeds Children Hospital, Leeds, UK
| | - P Jassar
- Department of ENT, Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | - T Wilson
- Department of ENT, Leeds General Infirmary, Leeds, UK
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3
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Bilateral acute mastoiditis and subperiosteal abscesses in a child managed by simultaneous bilateral mastoid surgery. The Journal of Laryngology & Otology 2012; 126:825-9. [DOI: 10.1017/s002221511200117x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjective:We report a case of bilateral acute mastoiditis and subperiosteal abscesses successfully managed with simultaneous surgery.Method:A case report and literature review are presented.Results:A two-year-old boy presented with fever, otalgia, otorrhoea and bilateral protruding ears. He was treated for 72 hours with intravenous antibiotics but failed to improve. Computed tomography confirmed bilateral mastoid abscesses with destruction of the mastoid cortex. Bilateral drainage of the subperiosteal abscesses and bilateral cortical mastoidectomies were carried out. Post-operatively, he recovered well, and free field audiometry showed a normal hearing threshold of 20 dB across all test frequencies.Conclusion:This is only the second reported case of bilateral mastoiditis and subperiosteal abscesses. This case illustrates the use of bilateral cortical mastoidectomy in the successful management of this condition following failed antibiotic therapy, and highlights important management considerations.
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4
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Genetic prothrombotic factors in children with otogenic lateral sinus thrombosis. Blood Coagul Fibrinolysis 2012; 23:158-63. [DOI: 10.1097/mbc.0b013e328349cafb] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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5
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Viswanatha B, Thriveni CN, Naseeruddin K. Nonseptic and septic lateral sinus thrombosis: a review. Indian J Otolaryngol Head Neck Surg 2011; 66:10-5. [PMID: 24533354 DOI: 10.1007/s12070-011-0422-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Accepted: 11/24/2011] [Indexed: 11/30/2022] Open
Abstract
Thrombosis of the lateral sinus can be classified into nonseptic lateral sinus thrombosis and septic lateral sinus thrombosis. Nonseptic lateral sinus thrombosis differs from septic lateral sinus thrombosis in that it is not associated with ear or sinus infection. Etiologies of these conditions are different and hence the management of these conditions is different. Nonseptic lateral sinus thrombosis requires medical line of management and anticoagulant therapy, where as septic lateral sinus thrombosis needs surgical treatment along with antibiotics therapy. An otologist should be familiar with the septic lateral sinus thrombosis existence and nonseptic variant lateral sinus thrombosis for early recognition and initiation of appropriate treatment.
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Affiliation(s)
- B Viswanatha
- Bangalore Medical College & Research Institute, # 716, 10th Cross, 5th Main, M.C. Layout, Vijayanagar, Bangalore, 560 040 Karnataka India
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6
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Abstract
A retrospective study was undertaken to review the clinical presentation, evaluation, management, and outcome of otogenic lateral sinus thrombosis (LST) in children. All pediatric patients with LST seen in our department between 1999 and 2007 were included; there were 9 cases involving 6 boys and 3 girls whose ages ranged from 8 to 12 years. They had all been treated with antibiotics elsewhere prior to admission, and the duration of symptoms before admission ranged from 5 to 18 days. The most common presenting symptoms were ear discharge, headache, otalgia, and fever. Radiologic evaluation included computed tomography and magnetic resonance imaging. All patients underwent radical mastoidectomy with incision of the lateral sinus and removal of its content. There were no deaths. Pseudomonas and Proteus spp were the most commonly identified organisms. Otogenic LST still poses a serious threat that warrants immediate attention and care. It is often associated with other intracranial complications, such as cerebellar abscess. Computed tomography and magnetic resonance imaging play an important role in the management of this disease. Early and aggressive surgical intervention of this otogenic complication can potentially minimize mortality.
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Affiliation(s)
- Borlingegowda Viswanatha
- Department of ENT, Victoria Hospital and Bangalore Medical College and Research Institute, Bangalore, India.
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7
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Abstract
Otitic hydrocephalus is a rare intracranial complication of otitis media. It is characterized by elevated cerebrospinal fluid (CSF) pressure with normal CSF biochemistry and without any focal neurologic abnormality other than those related to the increased intracranial pressure. The pathophysiology of this rare condition is unknown. The incidence of intracranial complications was reduced dramatically with the introduction of newer antibiotics, but complicated cases still occur. Serious consequences can ensue if complications are not identified and treated properly. The author reviews the literature on otitic hydrocephalus and describes 2 new cases.
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Affiliation(s)
- Borlingegowda Viswanatha
- Department of ENT, Victoria Hospital and Bangalore Medical College and Research Institute, Bangalore, Karnataka, India.
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8
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Viswanatha B, Naseeruddin K. Lateral sinus thrombosis in otology: a review. Mediterr J Hematol Infect Dis 2010; 2:e2010027. [PMID: 21415979 PMCID: PMC3033149 DOI: 10.4084/mjhid.2010.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2010] [Accepted: 08/27/2010] [Indexed: 11/08/2022] Open
Abstract
Lateral sinus thrombosis (LST) is usually occurs as a complication of middle ear infection. The involvement of lateral sinus during the course of ear infection was a well known complication in preantibiotic days. The decrease in the incidence of LST is due to the introduction of broad-spectrum antibiotics, early diagnosis and surgical treatment. Now, it is a rare complication of otitis media and poses a serious threat that warrants immediate medical and surgical treatment. The classical clinical picture is often changed by previous antibiotic therapy. An awareness of this rare potentially devastating condition and its varied presentations is necessary for early diagnosis and treatment. LST can also occur after head injury.Anticoagulants are recommended in cases LST, where there is propagation of thrombus after surgery. The use of anticoagulants is not apart of standard care of patients with LST and was more common prior to the advent of antibiotics. Anticoagulants arrests the spread of thrombosis but may increase the risk of venous infarctions and should be used cautiously.
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Affiliation(s)
- B. Viswanatha
- Professor of ENT, Victoria Hospital, Bangalore Medical College & Research Institute, Bangalore., INDIA
| | - Khaja Naseeruddin
- Professor of ENT, Joint Director of Medical Education, Bangalore., INDIA
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9
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Reis CVC, Deshmukh V, Zabramski JM, Crusius M, Desmukh P, Spetzler RF, Preul MC. Anatomy of the mastoid emissary vein and venous system of the posterior neck region: neurosurgical implications. Neurosurgery 2008; 61:193-200; discussion 200-1. [PMID: 18091233 DOI: 10.1227/01.neu.0000303217.53607.d9] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The superficial venous system of the posterior neck (suboccipital venous plexus) is a potential source of complications from bleeding and air embolism. Because there is little information available about this in the literature, an anatomic study of the superficial posterior neck venous system and a morphometric analysis of the mastoid emissary vein (MEV) complex were undertaken. Both surgical and endovascular implications were considered. METHODS The posterior craniocervical regions of 15 silicon-injected human cadaveric specimens were dissected. The patterns and variances of venous anatomy were observed. Distances between fixed bony landmarks were measured with a caliper. RESULTS The suboccipital venous plexus, which forms a complex venous network located between the posterior muscular layers of the neck, drains to the anterior vertebral vein and deep cervical vein. The MEV connects this plexus to the sigmoid sinus. Its average diameter was 2.15 mm, and it was located a mean of 21.14 mm from the asterion and a mean of 33.65 mm from the mastoid tip. However, the size of the MEV complex varied considerably. CONCLUSION The suboccipital venous plexus in the posterior neck region may be very large. The size of the veins in the plexus varies, but the drainage pattern remains consistent. The plexus is a potential source of intense bleeding and air embolism during posterior fossa approaches. The risks are greatest for lateral surgical approaches, as a result of the anatomic position of the venous system. The described measurements can be used to approach the MEV in endovascular procedures that involve the sigmoid sinus.
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Affiliation(s)
- Cassius V C Reis
- Neurosurgery Research Laboratory, Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona 85013, USA
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10
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Viswanatha B. Lateral sinus thrombosis: A major problem still with us. Indian J Otolaryngol Head Neck Surg 2007; 59:24-7. [PMID: 23120378 DOI: 10.1007/s12070-007-0006-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Twelve cases of lateral sinus thrombosis, which occurred as a complication of attico antral type of chronic otitis media, are reported. Management includes broad spectrum intravenous antibiotics and surgery. Radical mastoidectomy with incision of the lateral sinus and removal of its content was done for all cases. There were no deaths. The prognosis of lateral sinus thrombosis is good if treatment is instituted early with broad-spectrum antibiotics and surgery.
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Affiliation(s)
- B Viswanatha
- Dept. of ENT, Victoria Hospital and Bangalore, MedicalCollege, Bangalore, 560 002 Karnataka India
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11
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Oestreicher-Kedem Y, Raveh E, Kornreich L, Yaniv I, Tamary H. Prothrombotic Factors in Children with Otitis Media and Sinus Thrombosis. Laryngoscope 2004; 114:90-5. [PMID: 14710001 DOI: 10.1097/00005537-200401000-00015] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Venous sinus thrombosis (VST) is the second most common intracranial complication of acute otitis media (AOM). There is some evidence that hereditary and acquired prothrombotic disorders are risk factors for VST. The aim of the present study was to evaluate whether children with AOM complicated VST have a prothrombotic tendency, which might have important therapeutic and preventive implications. STUDY DESIGN Retrospective. METHODS The files of children hospitalized at Schneider Children's Medical Center of Israel, a tertiary referral center, from 1999 to 2002, because of AOM complicated by acute mastoiditis and VST were reviewed. All children underwent laboratory work-up for hypercoagulability. RESULTS Seven children met the study criteria. Of these, five had prothrombotic disorders, namely elevated levels of lipoprotein apolipoprotein (Lp[a]) (n = 4), antibodies to beta 2-glycoprotein and to cardiolipin (markers of antiphospholipid syndrome) (n = 4), and heterozygosity for factor V Leiden mutation (n = 1). One child had three abnormalities, two children had two abnormalities, and two children had one abnormality. CONCLUSIONS A prothrombotic tendency may exist in children with AOM complicated by mastoiditis and VST. Further studies are needed to evaluate its extent.
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Affiliation(s)
- Yael Oestreicher-Kedem
- Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center, Beilinson Campus, Israel.
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12
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Singh P, Tuli A, Choudhry R, Dhall U, Makwane UK. Morphology and imaging of bony projections on sigmoid sulcus with clinical implication. Surg Radiol Anat 2003; 26:46-50. [PMID: 14648034 DOI: 10.1007/s00276-003-0173-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2002] [Accepted: 04/02/2003] [Indexed: 11/28/2022]
Abstract
Morphologically diverse osseous projections were observed on the anterior lip of the sigmoid sulcus in a study conducted on 318 dry unsexed adult human skulls belonging to the Indian race. For convenience of description, this lip was divided into a longer lateral part, a shorter medial part and a junctional angular part having bony attributes characterized into three types, crests (42.9%), plates (22.3%) and bridges (13.5%). The bridges were subtyped into incomplete (11.8%) and complete (1.7%). Crests and plates were present anywhere along this lip, while bridges were confined to the angle. Right and left differences were analyzed, which showed that the above findings were more frequent on the right than the left. Plates showed a higher incidence of variation between right and left sides as compared to crests and bridges. Five cadavers were studied, which showed retinacular bands attached to the projections blending with dura mater over the foramen magnum. It is postulated that these projections are caused by the traction of the fibrous dural bands. Axial CT scan revealed partial and complete osseous bridges spanning the sulcus. These projections are of relevance to surgeons working at the cerebellopontine angle. Their presence has not been reported previously.
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Affiliation(s)
- P Singh
- Department of Anatomy, Lady Hardinge Medical College, 11001 New Delhi, India.
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13
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Unsal EE, Ensari S, Koç C. A rare and serious complication of chronic otitis media: lateral sinus thrombosis. Auris Nasus Larynx 2003; 30:279-82. [PMID: 12927292 DOI: 10.1016/s0385-8146(03)00044-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Before the antibiotic era, lateral sinus thrombosis (LST) was the most frequent complication of otitis media. With the widespread usage of antibiotics, its occurrence is rare. Nevertheless, it is still a major complication of middle ear disease. LST mortality fluctuates between 5 and 35%. The major clinical symptoms of patients with LST are pain in the mastoid region, spiking fever, anemia and general health disorders. Computed tomography, magnetic resonance imaging and angiography are the most helpful in diagnosis, but the final diagnosis is made by surgical exploration. Three cases with LST are presented, and signs, diagnosis and treatment of disease are discussed.
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Affiliation(s)
- Evrim E Unsal
- Department of Otolaryngology and Head and Neck Surgery, Ankara Numune Hospital, Ankara, Turkey.
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14
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Affiliation(s)
- Jemy Jose
- Department of Otolaryngology, Leeds General Infirmary, Great George Street, Leeds LS1 3EX.
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15
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Abstract
Venous strokes are not as common as arterial strokes in the pediatric population, but may be associated with significant mortality and morbidity. Cerebral vein thrombosis and venous sinus thrombosis are responsible for most venous strokes. Vein of Galen malformation is a rare but important cause of mortality in neonates and infants. Awareness of these potential causes of stroke in the pediatric population, early diagnosis, and appropriate therapeutic strategies are paramount to reduce mortality and improve neurologic outcome.
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Affiliation(s)
- Karen S Carvalho
- James Whitcomb Riley Hospital for Children, Section of Pediatric Neurology, Indiana University Medical Center, 702 Barnhill Drive, Room #1757, Indianapolis, IN 46202-5200, USA.
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Martinez SA, Mcnellis EL, Weber PC, Adkins WY. Bilateral acute coalescent mastoiditis in an immunocompromised infant with a rare leukocyte adhesion deficiency. Otolaryngol Head Neck Surg 1999; 120:926-8. [PMID: 10352452 DOI: 10.1016/s0194-5998(99)70339-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- S A Martinez
- Department of Otolaryngology and Communicative Sciences, Medical University of South Carolina, Charleston, USA
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17
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Gupta AK, Nagarkar NM, Mann SB, Gupta SK. Bilateral otogenic temporal lobe and post-aural abscesses. J Laryngol Otol 1997; 111:284-5. [PMID: 9156071 DOI: 10.1017/s0022215100137107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
AbstractA rare case of bilateral unsafe CSOM with bilateral post aural and temporal lobe abscesses is reported with a relevant review of literature.
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Affiliation(s)
- A K Gupta
- Department of Otolaryngology, Head and Neck Surgery and Neuro Surgery, Postgraduate Institute of Medical Education and Research, Chandiagrh 160012, India
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19
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Hadeishi H, Yasui N, Suzuki A. Mastoid canal and migrated bone wax in the sigmoid sinus: technical report. Neurosurgery 1995; 36:1220-3; discussion 1223-4. [PMID: 7644009 DOI: 10.1227/00006123-199506000-00028] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
A study of the migration of bone wax into the sigmoid sinus through the mastoid canal is reported here. In 7 of 161 patients who underwent retromastoid craniectomy, the postoperative soft tissue window image computed tomographic scans demonstrated a hypodense mass in the ipsilateral sigmoid sinus. The density value of the hypodense mass ranged from -34 to -79 Hounsfield units, which was neither as low as that of air nor as high as that of cerebrospinal fluid, but was comparable to that of fat tissue or bone wax. The continued presence of all of these masses in the sigmoid sinus was confirmed 1 month to 2 years after surgery. These computed tomographic findings suggested that this abnormal hypodense mass might be a migrated fragment of the bone wax that had been used for the control of venous bleeding from the mastoid emissary vein, because each of the seven affected patients had a large mastoid foramen and a large quantity of bone wax had been needed to control the bleeding during retromastoid craniectomy. No other material with the potential to migrate into the sigmoid sinus had been applied as a packing material. In two of the seven patients, venous magnetic resonance angiography after surgery demonstrated that the ipsilateral sigmoid sinus was not patent and the computed tomographic scans also revealed that the hypodense masses occupied the sigmoid sinus. It is concluded that the intrasurgical application of a large quantity of bone wax to control the bleeding from the large emissary veins carries a risk of the migration of bone wax into the sigmoid sinus.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- H Hadeishi
- Department of Surgical Neurology, Research Institute for Brain and Blood Vessels-Akita, Japan
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20
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Abstract
Although otitis media is easily recognized in the emergency department, its complications can often be missed. We present the case of a patient with mastoiditis with lateral sinus thrombosis that was not diagnosed until a digital subtraction angiogram revealed the occlusion.
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Affiliation(s)
- E Grafstein
- Department of Emergency Medicine, Saint Paul's Hospital, Vancouver, British Columbia, Canada
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21
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Pearson CR, Riden DK, Garth RJ, Thomas MR. Two cases of lateral sinus thrombosis presenting with extracranial head and neck abscesses. J Laryngol Otol 1994; 108:779-82. [PMID: 7964144 DOI: 10.1017/s0022215100128105] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Two cases of lateral sinus thrombosis in fit adults with no previous otological history are presented. One case occurred in association with Bezold's abscess and followed mastoiditis which was masked by previous antibiotic treatment. The other case occurred in association with an occipitoparietal scalp abscess and there was no obvious preceding middle ear infection. The causative bacteria were Streptococcus milleri and a variant Streptococcus intermedius. Lateral sinus thrombosis is discussed.
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Affiliation(s)
- C R Pearson
- Department of Otolaryngology, Royal Naval Hospital, Haslar, Gosport, Hants
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