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Trevisi G, Giovanni P, Ciaffi G, Auricchio AM, Sturiale CL. Venous Sinus Thrombosis-Associated with Posterior Cranial Fossa Surgery. A Systematic Review and Meta-Analysis of Natural History, Risk Factors, Treatment, and Outcome. World Neurosurg 2024; 186:122-132. [PMID: 38531470 DOI: 10.1016/j.wneu.2024.03.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 03/15/2024] [Accepted: 03/16/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Venous sinus thromboses (VSTs) are rare complications of neurosurgical procedures in the proximity of the dural sinuses. Surgery of the posterior cranial fossa (PCF) and particularly of the cerebellopontine angle (CPA) shows increased risk of VST. VST management is challenging because anticoagulant therapy must be balanced with the risk of postoperative bleeding. We performed a systematic review and meta-analysis to summarize the most important neuroradiologic and clinical aspects of VST after PCF/CPA surgery. METHODS We performed a comprehensive literature search to identify articles reporting data on VST after PCF/CPA surgery. We selected only comparative studies providing adequate neuroimaging assessing VST and a control group. RESULTS We included 13 articles reporting 1855 patients. VST occurred in 251/1855 cases (estimated incidence, 17.3%; 95% confidence interval [CI], 12.4%-22.2%). Only presigmoid approach (odds ratio [OR], 2.505; 95% CI, 1.161-5.404; P = 0.019) and intraoperative sinus injury (OR, 8.95; 95% CI, 3.43-23.34; P < 0.001) showed a significant association with VST. VST-related symptoms were reported in 12/251 patients with VST (pooled incidence, 3.1%; 95% CI, 1%-5.2%). In particular, we found a significantly increased OR of cerebrospinal fluid leak (OR, 3.197; 95% CI, 1.899-5.382; P < 0.001) and cerebrospinal fluid dynamic alterations in general (OR, 3.625; 95% CI, 2.370-5.543; P < 0.001). Indications for VST treatment were heterogeneous: 58/251 patients underwent antithrombotics, with 6 treatment-related bleedings. Recanalization overall occurred in 56.4% (95% CI, 40.6%-72.2%), with no significant difference between treated and untreated patients. However, untreated patients had a favorable outcome. CONCLUSIONS VST is a relatively frequent complication after PCF/CPA surgery and a presigmoid approach and intraoperative sinus injury represent the most significant risk factors. However, the clinical course is generally benign, with no advantage of antithrombotic therapy.
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Affiliation(s)
- Gianluca Trevisi
- Department of Neurosciences, Imaging and Clinical Sciences, G. D'Annunzio University, Chieti-Pescara, Italy
| | - Pennisi Giovanni
- Fondazione Policlinico Universitario A, GemelliIRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gabriele Ciaffi
- Fondazione Policlinico Universitario A, GemelliIRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Anna Maria Auricchio
- Fondazione Policlinico Universitario A, GemelliIRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carmelo Lucio Sturiale
- Fondazione Policlinico Universitario A, GemelliIRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
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Duan Z, Zhou C, Yan X, Du W, Xia X, Shi H, Su H, Zhang Y, He X, Xiong Q. Efficacy and safety of a "radical" surgical strategy in the treatment of parasagittal sinus meningioma. Front Neurol 2024; 15:1364917. [PMID: 38651111 PMCID: PMC11034519 DOI: 10.3389/fneur.2024.1364917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 03/27/2024] [Indexed: 04/25/2024] Open
Abstract
Background No standardized criteria for surgical resection of parasagittal sinus meningiomas (PSM) have been established, and different surgical strategies have been proposed. The aim of the present study was to investigate the efficacy and safety of a "radical" surgical strategy in the treatment of PSM. Methods The clinical histories, radiological findings, pathologic features, and surgical records of 53 patients with PSM admitted by the same surgical team using the "radical" surgical strategy were retrospectively analyzed between 2018 and 2023. Results Among the 53 PSM cases, 16 (30.2%) had a patent sinus proper, 28 (52.8%) had partial obstruction of the sinus proper, and 9 (17.0%) had complete obstruction of the sinus proper before the operation. During operation, Simpson grade I resection was performed in 34 (64.2%) cases and Simpson grade II in 19 (35.8%) cases. Postoperative pathologic examination suggested tumors of WHO grade I in 47 (88.7%) cases, WHO grade II in 4 (7.5%) cases, and WHO grade III in 2 (3.8%) cases. Postoperative complications primarily included a small amount of delayed intracerebral hemorrhage in 3 (5.7%) cases, exacerbation of cerebral edema in 3 (5.7%) cases, exacerbation of motor and sensory deficits in 4 (7.5%) cases, and intracranial infection in 2 (3.8%) cases. There were no cases of death or new-onset neurological dysfunction. Dizziness and headache symptoms improved to varying degrees, and a seizure-free status was achieved postoperatively. Excluding one case lost to follow-up, the average follow-up period was 33 months, and there were no cases of recurrence. Conclusion A "radical" strategy for the surgical management of PSM is effective, safe, and simple to perform, provided that the sagittal sinus is properly managed and its associated veins are protected.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Qijiang Xiong
- Department of Neurosurgery, the Affiliated Yongchuan Hospital of Chongqing Medical University, Chongqing, China
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Sturiale CL, Auricchio AM, Valente I, Vacca A, Pennisi G, Ciaffi G, Albanese A, Olivi A, Trevisi G. Post-operative segmental cerebral venous sinus thrombosis: risk factors, clinical implications, and therapeutic considerations. Neurosurg Rev 2023; 46:161. [PMID: 37395915 PMCID: PMC10317877 DOI: 10.1007/s10143-023-02067-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/31/2023] [Accepted: 06/20/2023] [Indexed: 07/04/2023]
Abstract
Cerebral venous sinus thromboses (CVSTs) are rare complications of neurosurgical interventions and their management remains controversial as most of cases appear clinically silent. Here, we analyzed our institutional series of patients with CVSTs evaluating clinical and neuroradiological characteristics, risk factors, and outcome. From the analysis of our institutional PACS, we collected a total of 59 patients showing postoperative CVSTs after supratentorial or infratentorial craniotomies. For every patient, we collected demographics and relevant clinical and laboratory data. Details on thrombosis trend were retrieved and compared along the serial radiological assessment. A supratentorial craniotomy was performed in 57.6% of cases, an infratentorial in 37.3%, while the remaining were a single cases of trans-sphenoidal and neck surgery (1.7%, respectively). A sinus infiltration was present in almost a quarter of patients, and in 52.5% of cases the thrombosed sinus was exposed during the craniotomy. Radiological signs of CVST were evident in 32.2% of patients, but only 8.5% of them developed a hemorrhagic infarct. CVST-related symptoms were complained by 13 patients (22%), but these were minor symptoms in about 90%, and only 10% experienced hemiparesis or impaired consciousness. The majority of patients (78%) remained completely asymptomatic along the follow-up. Risk factors for symptoms occurrence were interruption of preoperative anticoagulants, infratentorial sinuses involvement and evidence of vasogenic edema and venous infarction. Overall, a good outcome defined mRS 0-2 was observed in about 88% of patients at follow-up. CVST is a complication of surgical approaches in proximity of dural venous sinuses. CVST usually does not show progression and courses uneventfully in the vast majority of cases. The systematic use of post-operative anticoagulants seems to not significantly influence its clinical and radiological outcome.
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Affiliation(s)
- Carmelo Lucio Sturiale
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, L.go A. Gemelli, 8 - 00168, Rome, Italy.
| | - Anna Maria Auricchio
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, L.go A. Gemelli, 8 - 00168, Rome, Italy
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Iacopo Valente
- Department of Radiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, L.go A. Gemelli, 8 - 00168, Rome, Italy
| | - Alessandro Vacca
- Department of Radiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, L.go A. Gemelli, 8 - 00168, Rome, Italy
| | - Giovanni Pennisi
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, L.go A. Gemelli, 8 - 00168, Rome, Italy
| | - Gabriele Ciaffi
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, L.go A. Gemelli, 8 - 00168, Rome, Italy
| | - Alessio Albanese
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, L.go A. Gemelli, 8 - 00168, Rome, Italy
| | - Alessando Olivi
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, L.go A. Gemelli, 8 - 00168, Rome, Italy
| | - Gianluca Trevisi
- Department of Neurosciences, Imaging and Clinical Sciences, G. D'Annunzio University, Chieti-Pescara, Italy
- Neurosurgical Unit, Ospedale Spirito Santo, Pescara, Italy
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Shabo E, Wach J, Hamed M, Güresir Á, Weinhold L, Vatter H, Güresir E. Asymptomatic Postoperative Cerebral Venous Sinus Thrombosis After Posterior Fossa Tumor Surgery: Incidence, Risk Factors, and Therapeutic Options. Neurosurgery 2023; 92:1171-1176. [PMID: 36728332 DOI: 10.1227/neu.0000000000002340] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 11/04/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Cerebral venous sinus thrombosis (CVST) is a known complication of posterior fossa surgery near the sigmoid and transverse sinus. The incidence and treatment of postoperative asymptomatic CVST are controversial. OBJECTIVE To analyze incidence, risk factors, and management of asymptomatic postoperative CVST after posterior fossa tumor surgery. METHODS In this retrospective, single-center study, we included all patients who underwent posterior fossa tumor surgery in the semisitting position between January 2013 and December 2020. All patients underwent preoperative and postoperative imaging using MRI with/without additional computed tomography angiography. We analyzed the effect of demographic and surgical data on the incidence of postoperative CVST. Furthermore, therapeutic anticoagulation or conservative treatment for postoperative CVST and the incidence of intracranial hemorrhage were investigated. RESULTS In total, 266 patients were included. Thirty-three of 266 (12.4%) patients developed postoperative CVST. All patients were asymptomatic. Thirteen of 33 patients received therapeutic anticoagulation, and 20 patients did not. Univariate analysis showed that age ( P = .56), sex ( P = .20), American Society of Anesthesiology status ( P = .13), body mass index ( P = .60), and length of surgery ( P = .176) were not statistically correlated with postoperative CVST. Multivariate analysis revealed that meningioma ( P < .001, odds ratio 11.3, CI 95% 4.1-31.2) and vestibular schwannoma ( P = .013, odds ratio 4.4, CI 95% 1.3-16.3) are risk factors for the development of new postoperative CVST. The use of therapeutic anticoagulation to treat postoperative CVST was associated with a higher rate of intracranial hemorrhage (n = 4, P = .017). CONCLUSION Tumor entity influences the incidence of postoperative CVST. In clinically asymptomatic patients, careful decision making is necessary whether to initiate therapeutic anticoagulation or not.
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Affiliation(s)
- Ehab Shabo
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Johannes Wach
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Motaz Hamed
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Ági Güresir
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Leonie Weinhold
- Department of Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, 53127 Bonn, Germany
| | - Hartmut Vatter
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Erdem Güresir
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
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Paybast S, Mohamadian R, Emami A, Jameie M, Shahrab F, Zamani F, Sharifipour E. Safety and efficacy of endovascular thrombolysis in patients with acute cerebral venous sinus thrombosis: A systematic review. Interv Neuroradiol 2022:15910199221143418. [PMID: 36471504 DOI: 10.1177/15910199221143418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
INTRODUCTION Cerebral venous sinus thrombosis (CVST) is an uncommon but fatal cause of stroke worldwide. Endovascular treatments could be life-saving in patients who don't treat with anticoagulants as a mainstay of treatment. Currently, there is no consensus considering the safety, efficacy, and also selected approaches of endovascular intervention for these patients. This systematic review evaluates the literature on endovascular thrombolysis (EVT) in CVST patients. MATERIALS AND METHODS A comprehensive search was conducted through PubMed and Scopus databases between 2010 and 2021, with additional sources identified through cross-referencing. The primary outcomes were the safety and efficacy of EVT in CVST, including catheter-related and non-catheter-related complications, clinical outcomes, and radiological outcomes. RESULTS A total of 10 studies comprising 339 patients were included. Most of the patients presented with headaches (86.72%) and/or focal neurologic deficits (45.43%) (modified Rankin Scale of 5 in 55.88%). Acquired coagulopathy and/or consuming estrogen/progesterone medication were the most frequent predisposing factors (45.59%). At presentation, 68.84% had multi-sinus involvement, and 28.90% had venous infarcts and/or intracranial hemorrhage (ICH). The overall complication rate was 10.3%, with a 2.94%, 1.47%, and 1.17% rate of ICH, herniation, and intracranial edema, respectively. The complete and partial postoperative radiographic resolution was reported in 89.97% of patients, increasing to 95.21% during the follow-up. Additionally, 72.22% of patients had no or mild neurologic deficit at discharge, rising to 91.18% at the last follow-up. The overall mortality rate was 7.07%. CONCLUSIONS EVT can be an effective and safe treatment option for patients with refractory CVST or contraindications to systemic anticoagulation.
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Affiliation(s)
- Sepideh Paybast
- Neurology Department and Stroke Unit, Shohada-Tajrish Tertiary University Hospital, 48504Shahid-Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Mohamadian
- Radiology Department, 87255Eastern Clinical University Hospital, Stradins University, Riga, Latvia
| | - Ali Emami
- Research Committee, 48491Qazvin University of Medical Sciences, Qazvin, Iran
| | - Melika Jameie
- Neurology Department and Stroke Unit, Shohada-Tajrish Tertiary University Hospital, 48504Shahid-Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereshteh Shahrab
- 154202Neuroscience Research Center of Qom University of Medical Sciences, Qom, Iran
| | - Farideh Zamani
- 154202Neuroscience Research Center of Qom University of Medical Sciences, Qom, Iran
| | - Ehsan Sharifipour
- Neurology Department and Stroke Unit, Shohada-Tajrish Tertiary University Hospital, 48504Shahid-Beheshti University of Medical Sciences, Tehran, Iran
- 154202Neuroscience Research Center of Qom University of Medical Sciences, Qom, Iran
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Gerges C, Malloy P, Rabah N, Defta D, Duan Y, Wright CH, van Keulen M, Wright J, Mowry S, Megerian CA, Bambakidis N. Functional Outcomes and Postoperative Cerebral Venous Sinus Thrombosis after Translabyrinthine Approach for Vestibular Schwannoma Resection: A Radiographic Demonstration of Anatomic Predictors. Skull Base Surg 2022; 83:e89-e95. [DOI: 10.1055/s-0040-1722716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 11/25/2020] [Indexed: 10/22/2022]
Abstract
Abstract
Introduction While regarded as an effective surgical approach to vestibular schwannoma (VS) resection, the translabyrinthine (TL) approach is not without complications. It has been postulated that postoperative cerebral venous sinus thrombosis (pCVST) may occur as a result of injury and manipulation during surgery. Our objective was to identify radiologic, surgical, and patient-specific risk factors that may be associated with pCVST.
Methods The Institutional Review Board (IRB) approval was obtained and the medical records of adult patients with VS who underwent TL craniectomy at University Hospitals Cleveland Medical Center between 2009 and 2019 were reviewed. Demographic data, radiographic measurements, and tumor characteristics were collected. Outcomes assessed included pCVST and the modified Rankin score (mRS).
Results Sixty-one patients ultimately met inclusion criteria for the study. Ten patients demonstrated radiographic evidence of thrombus. Patients who developed pCVST demonstrated shorter internal auditory canal (IAC) to sinus distance (mean: 22.5 vs. 25.0 mm, p = 0.044) and significantly smaller petrous angles (mean: 26.3 vs. 32.7 degrees, p = 0.0045). Patients with good mRS scores (<3) appeared also to have higher mean petrous angles (32.5 vs. 26.8, p = 0.016). Koos' grading and tumor size, in our study, were not associated with thrombosis.
Conclusion More acute petrous angle and shorter IAC to sinus distance are objective anatomic variables associated with pCVST in TL surgical approaches.
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Affiliation(s)
- Christina Gerges
- Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
| | - Patrick Malloy
- Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
| | - Nicholas Rabah
- Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
| | - Dana Defta
- Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States
| | - Yifei Duan
- Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States
| | - Christina H. Wright
- Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States
| | - Marte van Keulen
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States
| | - James Wright
- Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States
| | - Sarah Mowry
- Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
- Department of Otolaryngology, Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States
| | - Cliff A. Megerian
- Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
- Department of Otolaryngology, Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States
| | - Nicholas Bambakidis
- Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States
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Sarathchandran P, Farooq S, Dar J, Khan M, AlRukn S. Frequency of Cerebral Venous Thrombosis in Dubai, UAE-A Multicenter, Retrospective Study. Ann Neurosci 2022; 28:122-128. [PMID: 35341233 PMCID: PMC8948320 DOI: 10.1177/09727531211047413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 08/30/2021] [Indexed: 11/15/2022] Open
Abstract
Background and Purpose Cerebral venous thrombosis (CVT), also known as cerebral dural venous thrombosis, is not a very common cause of stroke. It has a diverse clinical presentation, with multiple predisposing factors and imaging findings. The incidence of CVT varies in different studies. We hypothesized that the incidence of CVT in Dubai is more than that reported in the West owing to dehydration caused by the high atmospheric temperature. Methods We retrospectively reviewed the medical records of all patients aged more than 13 years with appropriate International Classification of Diseases, 9th Revision, codes for the diagnosis of CVT from January 1, 2010 to December 31, 2018 from three major hospitals with an acute stroke service in Dubai, United Arab Emirates. Results We identified 138 patients who presented with CVT. The average frequency of CVT was 6.6 per 100,000 population. Fifty percent of the patients presented between May and September, which are considered the hottest months in the UAE. Headache was the most common presentation, followed by seizures. The most important risk factors were the use of oral contraceptive pills, anemia, and polycythemia. Our study showed a higher incidence of anemia, polycythemia, thrombophilia, and abnormal CT brain findings. Conclusion In our study, CVT was more common during the months of summer. Anemia and polycythemia were strongly associated with CVT. Public awareness about CVT, its higher incidence during summer months and strategies to avoid dehydration might be considered to reduce the incidence of CVT in summer months. However, larger studies are needed to confirm definite associations.
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Affiliation(s)
| | - Saba Farooq
- Department of Neurology, Rashid Hospital, Dubai, UAE
| | - Javeed Dar
- Department of Neurology, Rashid Hospital, Dubai, UAE
| | - Maria Khan
- Department of Neurology, Rashid Hospital, Dubai, UAE
| | - Suhail AlRukn
- Consultant Rashid hospital, Saudi-German hospital& City Hospital, Dubai
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Jimenez AE, Khalafallah AM, Botros D, Horowitz MA, Azmeh O, Lam S, Oliveira LAP, Chakravarti S, Liu S, Wu E, Wei O, Porras JL, Bettegowda C, Tamargo RJ, Brem H, Mukherjee D. The role of anticoagulation for superior sagittal sinus thrombosis following craniotomy for resection of parasagittal/parafalcine meningiomas. J Neurooncol 2021; 156:341-352. [PMID: 34855096 DOI: 10.1007/s11060-021-03916-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 11/27/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The safety and efficacy of anticoagulation in managing superior sagittal sinus (SSS) thrombosis remains unclear. The present study investigated the relationship between anticoagulation and cerebrovascular complications in parasagittal/parafalcine meningioma patients presenting with post-surgical SSS thrombosis. METHODS We analyzed 266 patients treated at a single institution between 2005 and 2020. Bivariate analysis was conducted using the Mann-Whitney U test and Fisher's exact test. Multivariate analysis was conducted using a logistic regression model. Blood thinning medications investigated included aspirin, warfarin, heparin, apixaban, rivaroxaban, and other novel oral anticoagulants (NOACs). A symptomatic SSS thrombosis was defined as a radiographically apparent thrombosis with new headaches, seizures, altered sensorium, or neurological deficits. RESULTS Our patient cohort was majority female (67.3%) with a mean age ([Formula: see text] SD) of 58.82 [Formula: see text] 13.04 years. A total of 15 (5.6%) patients developed postoperative SSS thrombosis and 5 (1.9%) were symptomatic; 2 (0.8%) symptomatic patients received anticoagulation. None of these 15 patients developed cerebrovascular complications following observation or anticoagulative treatment of asymptomatic SSS thrombosis. While incidence of any other postoperative complications was significantly associated with SSS thrombosis in bivariate analysis (p = 0.015), this association was no longer observed in multivariate analysis (OR = 2.15, p = 0.16) when controlling for patient age, sex, and anatomical location of the tumor along the SSS. CONCLUSIONS Our single-institution study examining the incidence of SSS thrombosis and associated risk factors highlights the need for further research efforts better prognosticate this adverse outcome. Conservative management may represent a viable treatment strategy for patients with SSS thrombosis.
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Affiliation(s)
- Adrian E Jimenez
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD, 21287, USA
| | - Adham M Khalafallah
- Department of Neurological Surgery, University of Miami School of Medicine, Miami, FL, 33136, USA
| | - David Botros
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD, 21287, USA
| | - Melanie A Horowitz
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD, 21287, USA
| | - Omar Azmeh
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD, 21287, USA
| | - Shravika Lam
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Leonardo A P Oliveira
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD, 21287, USA
| | - Sachiv Chakravarti
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD, 21287, USA
| | - Sophie Liu
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD, 21287, USA
| | - Esther Wu
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD, 21287, USA
| | - Oren Wei
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD, 21287, USA
| | - Jose L Porras
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD, 21287, USA
| | - Chetan Bettegowda
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD, 21287, USA
| | - Rafael J Tamargo
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD, 21287, USA
| | - Henry Brem
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD, 21287, USA
| | - Debraj Mukherjee
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD, 21287, USA.
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9
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Ge S, Wen JH, Kei PL. Cerebral venous thrombosis: a spectrum of imaging findings. Singapore Med J 2021; 62:630-635. [DOI: 10.11622/smedj.2021235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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10
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Zhao J, Liu K, Li S, Gao Y, Zhao L, Liu H, Fang H, Wu J, Sun S, Li Y, Song B, Xu Y. Prognostic nutritional index predicts clinical outcomes in patients with cerebral venous sinus thrombosis. BMC Neurol 2021; 21:404. [PMID: 34674659 PMCID: PMC8529735 DOI: 10.1186/s12883-021-02436-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 10/05/2021] [Indexed: 11/29/2022] Open
Abstract
Background Lower prognostic nutritional index (PNI) is related to the poor prognosis of cardiovascular diseases. However, little is known about PNI and its relationship with the prognosis of cerebral venous sinus thrombosis (CVST). Methods CVST patients were retrospectively identified from January 2013 till June 2019. Patients in the acute / subacute phase were selected as subjects. Poor prognosis was defined as a modified Rankin Scale (mRS) of 3–6. Multivariate logistic regression analysis was used to confirm if lower PNI was associated with a poor prognosis. Results A total of 297 subjects with follow-up data were enrolled. Thirty-three (11.1%) had a poor outcome. Multivariate logistic regression analysis suggested that PNI was an important predictive factor of poor outcome in acute/subacute CVST (odds ratio, 0.903; 95% CI, 0.833–0.978; P = 0.012). The optimal cut-off value for predicting the poor prognosis of PNI was 44.2. Kaplan-Meier analysis and log-rank test suggested that the lower the PNI value, the higher the mortality rate (P < 0.001). In addition, the nomogram that was set up showed that lower PNI was an index of poor prognosis. The c-index for acute/subacute patients with CVST was 0.872. Conclusion Lower PNI is correlated with a higher risk of adverse clinical outcomes in patients with acute/subacute CVST. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-021-02436-w.
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Affiliation(s)
- Jiawei Zhao
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, No.1 Eastern Jianshe Road, Zhengzhou, 450052, Henan, China
| | - Kai Liu
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, No.1 Eastern Jianshe Road, Zhengzhou, 450052, Henan, China
| | - Shen Li
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, No.1 Eastern Jianshe Road, Zhengzhou, 450052, Henan, China
| | - Yuan Gao
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, No.1 Eastern Jianshe Road, Zhengzhou, 450052, Henan, China
| | - Lu Zhao
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, No.1 Eastern Jianshe Road, Zhengzhou, 450052, Henan, China
| | - Hongbing Liu
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, No.1 Eastern Jianshe Road, Zhengzhou, 450052, Henan, China
| | - Hui Fang
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, No.1 Eastern Jianshe Road, Zhengzhou, 450052, Henan, China
| | - Jun Wu
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, No.1 Eastern Jianshe Road, Zhengzhou, 450052, Henan, China
| | - Shilei Sun
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, No.1 Eastern Jianshe Road, Zhengzhou, 450052, Henan, China
| | - Yusheng Li
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, No.1 Eastern Jianshe Road, Zhengzhou, 450052, Henan, China
| | - Bo Song
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, No.1 Eastern Jianshe Road, Zhengzhou, 450052, Henan, China.
| | - Yuming Xu
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, No.1 Eastern Jianshe Road, Zhengzhou, 450052, Henan, China.
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11
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Song Y, Ayoub N, Chen JX, Alyono JC, Welling DB. Pulmonary Embolism and Sigmoid Sinus Thrombosis After Translabyrinthine Vestibular Schwannoma Resection: A Retrospective Case Series. Ann Otol Rhinol Laryngol 2021; 131:683-689. [PMID: 34353140 DOI: 10.1177/00034894211036864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To describe the presentation and treatment of patients developing pulmonary embolism following translabyrinthine approach for vestibular schwannoma resection. METHODS This was a retrospective case series of patients at 2 academic tertiary medical centers who developed symptomatic pulmonary embolism post-operatively following translabyrinthine approach for vestibular schwannoma resection and were found to have evidence of sigmoid sinus thrombosis. RESULTS Three patients were identified to have post-operative pulmonary emboli after translabyrinthine approach for vestibular schwannoma resection with sigmoid sinus or internal jugular vein clots in the absence of lower extremity deep vein thrombosis. Caprini scores for these patients were 5 or lower. All patients underwent CT pulmonary angiography and were confirmed to have pulmonary emboli. Two were promptly anticoagulated with heparin drips and transitioned to long-term oral anticoagulation therapy and 1 had delayed anticoagulation. None of these patients suffered from intracranial hemorrhage post-operatively. CONCLUSIONS Patients undergoing translabyrinthine approach for vestibular schwannoma can develop pulmonary embolism from sigmoid sinus entry or thrombosis. No clear guidelines exist for the management of this complication in the setting of recent craniotomy and the risk of intracranial hemorrhage must be considered prior to initiating anticoagulation.
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Affiliation(s)
- Yohan Song
- Division of Otology and Neurotology, Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, MA, USA
| | - Noel Ayoub
- Division of Otology and Neurotology, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Jenny X Chen
- Division of Otology and Neurotology, Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, MA, USA
| | - Jennifer C Alyono
- Division of Otology and Neurotology, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, CA, USA
| | - D Bradley Welling
- Division of Otology and Neurotology, Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, MA, USA
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12
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Cerebral Venous Sinus Thrombosis After Translabyrinthine Vestibular Schwannoma-A Prospective Study and Suggested Management Paradigm. Otol Neurotol 2021; 41:e273-e279. [PMID: 31821255 DOI: 10.1097/mao.0000000000002508] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To prospectively evaluate the incidence, risk factors and natural history of postoperative cerebral venous sinus thrombosis (pCVST) in translabyrinthine vestibular schwannoma microsurgical resection and propose a potential management paradigm. STUDY DESIGN Prospective, single cohort, multicenter study. SETTING State-wide academic tertiary referral centers. PATIENTS Fifty-four consecutive patients who underwent translabyrinthine vestibular schwannoma resection. MAIN OUTCOME MEASURES Incidence of pCVST on postoperative imaging on Day 7, Day 28, and 12 months postoperatively. Patients and tumor characteristics, risk factors, length of stay, intraoperative parameters, complications, and follow-up were analyzed. RESULTS pCVST was demonstrated in 21 patients (38.9%) on postoperative imaging. All patients with pCVST were treated conservatively and remained asymptomatic in the immediate postoperative period and long-term follow-up. There were no instances of venous infarction, intracranial hemorrhage, or neurological deficits. A majority (61.1%) of pCVST recannalised on long-term follow up with conservative management. There was a statistical association with pCVST and surgery on the side of the non-dominant cerebral venous drainage (n = 17, 80.1%, p = 0.034). Patients with pCVST were significantly more likely to have a postoperative cerebrospinal fluid (CSF) leak (n = 5, 23.8%, p = 0.017). CONCLUSION The incidence of pCVST following translabyrinthine vestibular schwannoma resection is much higher than previously recognized. pCVST is more likely to occur when surgery is performed on tumors situated on the side of non-dominant cerebral venous drainage. Despite the high prevalence of this iatrogenic phenomenon, all patients were asymptomatic and a majority resolved, thereby suggesting that conservative management is safe. Correlation between pCVST and increased incidence of CSF leak requires further investigation.
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13
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John C, Ismail N, Clarke R, Anadure R. A study on the distinctive clinical profile and thrombophilia in pediatric cerebral venous sinus thrombosis. J Pediatr Neurosci 2021; 16:225-231. [PMID: 36160607 PMCID: PMC9496605 DOI: 10.4103/jpn.jpn_121_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 07/04/2020] [Accepted: 08/27/2020] [Indexed: 12/02/2022] Open
Abstract
Aim: The objective of the study was to systematically bring out the clinical presentations, neuro-imaging features, treatment given, and long-term outcomes of children with cerebral venous sinus thrombosis (CVST). Materials and Methods: Data were obtained by retrospective analysis of electronic records spanning 13 years, of children (<18 years) with a confirmed diagnosis of CVST based on magnetic resonance imaging of the brain and managed at a tertiary care children’s hospital in the UK. Results: Seventeen patients with pediatric CVST were identified over a 13-year study period, highlighting the uncommon prevalence of this entity. This study comprised 10 males and seven females. The age range at presentation was between 2 days and 17 years with a median age of 5.5 years. Headache was the commonest presenting symptom in 10 of 17 children and focal neurological signs were seen in 11 of 17 patients. Among risk factors, six patients had an antecedent infection of the ear/mastoid, three children had acute leukemia, and two patients had central venous catheters. Para-infectious CVST (seven of 17 patients) responded well to appropriate antibiotic therapy. Thrombophilia screens were available in 10 of 17 patients with noninfectious CVST and returned abnormal in four patients (two with Factor V Leiden mutations and one each with deficiency of protein C and anti-thrombin III). Anticoagulants were used in only six of 17 cases and were generally well tolerated. Follow-up data revealed, 11 of 17 patients had a complete recovery and four of 17 patients had residual neurological deficits. Two children died in the entire cohort. Conclusion: Pediatric CVST is uncommon and has a different spectrum from adults, with unique clinical triggers and thrombophilic states. Management varies significantly among clinicians, due to the paucity of trial evidence and also due to the heterogeneity of this condition in children.
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14
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Krajíčková D, Král J, Herzig R, Klzo Ľ, Krajina A, Havelka J, Šimůnek L, Vyšata O, Van Quang T, Bar M, Vališ M. Factors influencing therapy choice and clinical outcome in cerebral venous sinus thrombosis. Sci Rep 2020; 10:21633. [PMID: 33303787 PMCID: PMC7728772 DOI: 10.1038/s41598-020-78434-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 11/02/2020] [Indexed: 11/09/2022] Open
Abstract
We aimed was to assess the factors influencing therapy choice and clinical outcome after 3-4 months in patients with cerebral venous sinus thrombosis (CVST). In a retrospective, bi-centric study, the set consisted of 82 consecutive CVST patients (61 females; mean age 33.5 ± 15.7 years). Following data were collected: baseline characteristics, presence of gender-specific risk factors (GSRF), location and extent of venous sinus impairment, clinical presentation, type of treatment, recanalization, presence of parenchymal lesions, and clinical outcome after 3-4 months (assessed using the modified Rankin Scale [mRS], with excellent outcome defined as mRS 0-1). Multivariate logistic regression analysis was used for statistical evaluation. After 3-4 months, complete recovery was achieved in 41 (50%) and excellent clinical outcome in 67 (81.7%) patients. Female sex (OR 0.11; p = 0.0189) and presence of focal neurologic deficit (OR 0.16; p = 0.0165) were identified as significant independent negative predictors and, the presence of GSRF (OR 15.63; p = 0.0011) as significant independent positive predictor of excellent clinical outcome. In conclusion, in our CVST patients, the presence of GSRF was associated with excellent clinical outcome, while the female sex itself was associated with poorer clinical outcome.
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Affiliation(s)
- Dagmar Krajíčková
- Department of Neurology, Comprehensive Stroke Center, Charles University Faculty of Medicine and University Hospital, 500 05, Hradec Králové, Czech Republic
| | - Jiří Král
- Department of Neurology, University Hospital Ostrava and University of Ostrava Faculty of Medicine, 708 52, Ostrava, Czech Republic.,Department of Neurology, St. Anne's University Hospital and Medical Faculty of Masaryk University, 656 91, Brno, Czech Republic
| | - Roman Herzig
- Department of Neurology, Comprehensive Stroke Center, Charles University Faculty of Medicine and University Hospital, 500 05, Hradec Králové, Czech Republic
| | - Ľudovít Klzo
- Department of Radiology, Comprehensive Stroke Center, Charles University Faculty of Medicine and University Hospital, 500 05, Hradec Králové, Czech Republic
| | - Antonín Krajina
- Department of Radiology, Comprehensive Stroke Center, Charles University Faculty of Medicine and University Hospital, 500 05, Hradec Králové, Czech Republic
| | - Jaroslav Havelka
- Department of Radiology, University Hospital Ostrava and University of Ostrava Faculty of Medicine, 708 52, Ostrava, Czech Republic
| | - Libor Šimůnek
- Department of Neurology, Comprehensive Stroke Center, Charles University Faculty of Medicine and University Hospital, 500 05, Hradec Králové, Czech Republic
| | - Oldřich Vyšata
- Department of Neurology, Comprehensive Stroke Center, Charles University Faculty of Medicine and University Hospital, 500 05, Hradec Králové, Czech Republic
| | - Tran Van Quang
- Department of Mathematics, Faculty of Nuclear Sciences and Physical Engineering, Czech Technical University, 160 00, Prague, Czech Republic
| | - Michal Bar
- Department of Neurology, University Hospital Ostrava and University of Ostrava Faculty of Medicine, 708 52, Ostrava, Czech Republic
| | - Martin Vališ
- Department of Neurology, Comprehensive Stroke Center, Charles University Faculty of Medicine and University Hospital, 500 05, Hradec Králové, Czech Republic.
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15
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Bouziane M, Arous S, Habbal R. Cerebral venous thrombosis as a rare thromboembolic complication of celiac disease: a case report. Eur Heart J Case Rep 2020; 4:1-5. [PMID: 33204951 PMCID: PMC7649450 DOI: 10.1093/ehjcr/ytaa200] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 03/24/2020] [Accepted: 06/11/2020] [Indexed: 11/13/2022]
Abstract
BACKGROUND Celiac disease is a digestive inflammatory syndrome with several complications. It is associated with coagulation and platelets abnormalities leading to thromboembolic events. Cerebral venous thrombosis is an exceptional localization of thrombosis in celiac disease and could be life-threatening. CASE SUMMARY A 17-year-old female patient with history of celiac disease and not following a gluten-free diet, checked in to the emergency department for a sudden, 2-week-old, and deteriorating, onset of intense headache and muscle weakness. The cerebral computed tomography-scan showed bilateral fronto-parietal hypodensity with micro-bleeds. We investigated using a cerebral magnetic resonance imaging that revealed superior longitudinal sinus thrombosis and right transverse and sigmoid sinuses thrombosis, along with right haematoma and ischaemic areas. The patient was prescribed anticoagulation therapy. Follow-ups over a 2-year period confirmed a favourable outcome and a complete regression of symptoms. DISCUSSION Evolution of celiac disease could be associated with several complications. Eighty-five percent of patients is potentially exposed to thromboembolic events due to the hypercoagulability state of the disease and different coagulation and fibrinolysis abnormalities (e.g. hyperhomocysteinaemia, protein C and S deficiencies, vitamin K and B deficiencies). Cerebral venous thrombosis is a rare thromboembolic localization. Anticoagulation is efficient in most cases though endovascular treatment might be required.
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Affiliation(s)
- Maha Bouziane
- Cardiology Department, P37, Ibn Rochd University Hospital, 1, Rue des Hôpitaux, Quartier des Hôpitaux, Casablanca, Morocco
| | - Salim Arous
- Cardiology Department, P37, Ibn Rochd University Hospital, 1, Rue des Hôpitaux, Quartier des Hôpitaux, Casablanca, Morocco
| | - Rachida Habbal
- Cardiology Department, P37, Ibn Rochd University Hospital, 1, Rue des Hôpitaux, Quartier des Hôpitaux, Casablanca, Morocco
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16
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Long DA, Koyfman A, Long B. An emergency medicine-focused review of malignant otitis externa. Am J Emerg Med 2020; 38:1671-1678. [DOI: 10.1016/j.ajem.2020.04.083] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/19/2020] [Accepted: 04/23/2020] [Indexed: 10/24/2022] Open
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17
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Fan Y, Yu J, Chen H, Zhang J, Duan J, Mo D, Zhu W, Wang B, Ouyang F, Chen Y, Lan L, Zeng J. Chinese Stroke Association guidelines for clinical management of cerebrovascular disorders: executive summary and 2019 update of clinical management of cerebral venous sinus thrombosis. Stroke Vasc Neurol 2020; 5:152-158. [PMID: 32409571 PMCID: PMC7337369 DOI: 10.1136/svn-2020-000358] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 03/26/2020] [Accepted: 03/31/2020] [Indexed: 12/27/2022] Open
Abstract
Aim Cerebral venous sinus thrombosis (CVST) is a less common cerebrovascular disease that predominantly affects young patients. The incidence of CVST is 2–5/10 000 000/year, accounting for 0.5%–1% of all stroke. To reduce mortality and morbidity associated with CVST, Chinese Stroke Association commissioned the authors to write the current guideline on the management of CVST. Methods PubMed (MEDLINE), CNKI and Wanfang database were searched for studies related to CVST from 1 January 1990 to 31 July 2019. Data were synthesised by evidence tables. Each recommendation was fully discussed by the writing group members and reviewed by Chinese Stroke Association Stroke Fellow Committees. Levels of evidence grading algorithm of Chinese Stroke Association was used to grade each recommendation. Results This guideline mainly focuses on the diagnostic evaluation, therapeutic strategies and secondary prevention of CVST. CT/CTV and MRI/MRV are recommended in the initial imaging evaluation of patients with suspected CVST. Anticoagulation therapy with low-molecular weight heparin should be initiated in patients with CVST immediately. After the acute stage, warfarin is recommended for 3–6 months to prevent the recurrence of CVST and other venous thromboembolic events. Conclusions The guideline summarises the current evidence regarding the management of CVST, and provides references for diagnosis, treatment and secondary prevention of CVST in China.
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Affiliation(s)
- Yuhua Fan
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Jian Yu
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Hongbing Chen
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Jian Zhang
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Jiangang Duan
- Department of Neurology and Department of Emergency, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Dapeng Mo
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wenhao Zhu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bo Wang
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Fubing Ouyang
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Yicong Chen
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Linfang Lan
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Jinsheng Zeng
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
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18
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Brahimaj BC, Beer-Furlan A, Crawford F, Nunna R, Urban M, Wu G, Abello E, Chauhan V, Kocak M, Muñoz L, Wiet RM, Byrne RW. Dural Venous Sinus Thrombosis after Vestibular Schwannoma Surgery: The Anticoagulation Dilemma. J Neurol Surg B Skull Base 2019; 82:e3-e8. [PMID: 34306911 DOI: 10.1055/s-0039-3400296] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 09/27/2019] [Indexed: 10/25/2022] Open
Abstract
Introduction Dural venous sinus thrombosis (DVST) is a relatively understudied complication of vestibular schwannoma (VS) surgery. Several studies have examined this topic; however, there is limited data on the incidence, clinical progression, and proper management of this patient population. Methods A retrospective review was performed for patients undergoing surgery for VS at a single institution. All postoperative imaging was reviewed for incidence of DVST. Demographic data were collected including tumor and surgical characteristics along with postoperative course. Results A total of 63 patients underwent resection of their VS. The incidence of DVST was 34.9%. The operative time was greater in the dural venous sinus thrombosis (DSVT) group, at an average of 6.69 hours versus 4.87 in the no DSVT cohort ( p = 0.04). Tumor size was correlationally significant ( p = 0.051) at 2.75 versus 2.12 cm greatest diameter. The translabyrinthine approach was most prevalent (68.2%). The side of the thrombosis was ipsilateral to the tumor and surgery in all patients. The sigmoid sinus was most commonly involved (95.5%). Of them, 85% patients had a codominant or thrombus contralateral to the dominant sinus. All patients were asymptomatic. No patients were treated with anticoagulation. Resolution of thrombus was seen in five (22.7%) of the patients on last follow-up imaging. There were no hemorrhagic complications. Conclusion The overall incidence of DVST was (34.9%) of 63 patients who underwent VS surgery. All patients were asymptomatic and none were treated with anticoagulation. In our study, continuing to observe asymptomatic patients did not lead to any adverse events.
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Affiliation(s)
- Bledi C Brahimaj
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, United States
| | - Andre Beer-Furlan
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, United States
| | - Fred Crawford
- Rush University College of Medicine, Chicago, Illinois, United States
| | - Ravi Nunna
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, United States
| | - Matthew Urban
- Rush University College of Medicine, Chicago, Illinois, United States
| | - Gary Wu
- Rush University College of Medicine, Chicago, Illinois, United States
| | - Eric Abello
- Rush University College of Medicine, Chicago, Illinois, United States
| | - Vikrant Chauhan
- Department of Otolaryngology, Rush University Medical Center, Chicago, Illinois, United States
| | - Mehmet Kocak
- Department of Diagnostic Radiology, Rush University Medical Center, Chicago, Illinois, United States
| | - Lorenzo Muñoz
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, United States
| | - Richard M Wiet
- Department of Otolaryngology, Rush University Medical Center, Chicago, Illinois, United States
| | - Richard W Byrne
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, United States
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19
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Incidence and Risk Factors for Sigmoid Venous Thrombosis Following CPA Tumor Resection. Otol Neurotol 2019; 39:e376-e380. [PMID: 29738390 DOI: 10.1097/mao.0000000000001806] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Our primary aim was to determine the incidence of sigmoid venous thrombosis (SVT) and determine risks factors and sequelae of SVT following cerebellopontine angle tumor resection. STUDY DESIGN Retrospective cohort study. SETTING Academic tertiary care hospital. PATIENTS Patients over 18 years of age who underwent resection of cerebellopontine angle meningioma or vestibular schwannoma from January 2005 to April 2016 who had postoperative magnetic resonance imaging. INTERVENTION(S) Diagnostic. MAIN OUTCOME MEASURE(S) Incidence of postoperative sigmoid venous thrombosis (SVT) from official radiology reports was compared with retrospective imaging review by our institutional neuroradiologists. Data collected included age, length of stay, body mass index, surgical approach, and postoperative complications. RESULTS A total of 127 patients were identified. Official radiology reads significantly underreported the incidence of postoperative SVT compared with retrospective review by our institutional neuroradiologist for patients who underwent routine postoperative imaging (n = 4 [3.1%] versus n = 22 [17.3%]; p < 0.001). There was a statistical trend toward increased risk for thrombosis in patients undergoing translabyrinthine and staged resection that did not reach significance (p = 0.068). Cerebrospinal fluid (CSF) leak incidence in patients with thrombosis was significantly increased (n = 9 [37.5%] versus n = 13 [12.6%]; p = 0.007). When controlling for approach, the presence of thrombus was associated with a more then three-fold increase in odds of CSF leak (OR = 3.28, 95% CI: 1.12-9.48, p = 0.030). There was no correlation between SVT and age (p = 0.788), body mass index (p = 0.686), length of stay (p = 0.733), preoperative tumor size (p = 0.555), or increased postoperative ICP (p = 0.645). Only one patient was symptomatic from sigmoid thrombosis compared with 21 who were not. CONCLUSION Incidence of SVT is significantly underreported and may predispose patients to increase risk for CSF leak. Staged and translabyrinthine approaches demonstrate an increased trend toward thrombosis risk. Our findings suggest it may not be necessary to treat asymptomatic SVT.
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20
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Nishiyama Y, Ueda M, Muraga K, Ota T, Horikawa H, Kimura K. Successful endovascular recanalization of massive cerebral venous sinus thrombosis in a patient with tuberous sclerosis and protein S deficiency: a case report. Oxf Med Case Reports 2019; 2019:omz060. [PMID: 31312460 PMCID: PMC6624995 DOI: 10.1093/omcr/omz060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 05/11/2019] [Indexed: 11/13/2022] Open
Abstract
Here, we report the case of a 27-year-old woman with tuberous sclerosis complex who underwent successful endovascular intervention for cerebral venous thrombosis at the superior sagittal sinus. She had protein S deficiency and a long-term history of anemia caused by menorrhagia from uterine fibroids, possibly leading to a hypercoagulable state. Cerebral venous sinus thrombosis accounts for ~0.5–1% of all strokes. Several cases of venous thrombosis in patients with tuberous sclerosis complex and protein S or protein C deficiency have been reported, but further studies are needed to identify whether an association of this rare combination may be explained.
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Affiliation(s)
- Yasuhiro Nishiyama
- Department of Neurology and Stroke Medicine, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.,Department of Neurology, Nippon Medical School, Tokyo, Japan
| | - Masayuki Ueda
- Department of Neurology and Stroke Medicine, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Kanako Muraga
- Department of Neurology and Stroke Medicine, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.,Department of Neurology, Nippon Medical School, Tokyo, Japan
| | - Takahiro Ota
- Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Hiroshi Horikawa
- Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Kazumi Kimura
- Department of Neurology, Nippon Medical School, Tokyo, Japan
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21
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Benjamin CG, Sen RD, Golfinos JG, Sen C, Roland JT, McMenomey S, Pacione D. Postoperative cerebral venous sinus thrombosis in the setting of surgery adjacent to the major dural venous sinuses. J Neurosurg 2018; 131:1317-1323. [PMID: 30497227 DOI: 10.3171/2018.4.jns18308] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 04/23/2018] [Indexed: 11/06/2022]
Abstract
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.
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Affiliation(s)
| | - Rajeev D Sen
- 2Department of Neurosurgery, University of Washington, Seattle, Washington
| | | | | | - J Thomas Roland
- 3Otolaryngology, NYU Langone Medical Center, New York, New York; and
| | - Sean McMenomey
- 3Otolaryngology, NYU Langone Medical Center, New York, New York; and
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Neural Vascular Mechanism for the Cerebral Blood Flow Autoregulation after Hemorrhagic Stroke. Neural Plast 2017; 2017:5819514. [PMID: 29104807 PMCID: PMC5634612 DOI: 10.1155/2017/5819514] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 09/11/2017] [Indexed: 12/21/2022] Open
Abstract
During the initial stages of hemorrhagic stroke, including intracerebral hemorrhage and subarachnoid hemorrhage, the reflex mechanisms are activated to protect cerebral perfusion, but secondary dysfunction of cerebral flow autoregulation will eventually reduce global cerebral blood flow and the delivery of metabolic substrates, leading to generalized cerebral ischemia, hypoxia, and ultimately, neuronal cell death. Cerebral blood flow is controlled by various regulatory mechanisms, including prevailing arterial pressure, intracranial pressure, arterial blood gases, neural activity, and metabolic demand. Evoked by the concept of vascular neural network, the unveiled neural vascular mechanism gains more and more attentions. Astrocyte, neuron, pericyte, endothelium, and so forth are formed as a communicate network to regulate with each other as well as the cerebral blood flow. However, the signaling molecules responsible for this communication between these new players and blood vessels are yet to be definitively confirmed. Recent evidence suggested the pivotal role of transcriptional mechanism, including but not limited to miRNA, lncRNA, exosome, and so forth, for the cerebral blood flow autoregulation. In the present review, we sought to summarize the hemodynamic changes and underline neural vascular mechanism for cerebral blood flow autoregulation in stroke-prone state and after hemorrhagic stroke and hopefully provide more systematic and innovative research interests for the pathophysiology and therapeutic strategies of hemorrhagic stroke.
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23
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Salottolo K, Wagner J, Frei DF, Loy D, Bellon RJ, McCarthy K, Jensen J, Fanale C, Bar-Or D. Epidemiology, Endovascular Treatment, and Prognosis of Cerebral Venous Thrombosis: US Center Study of 152 Patients. J Am Heart Assoc 2017; 6:JAHA.117.005480. [PMID: 28611097 PMCID: PMC5669171 DOI: 10.1161/jaha.117.005480] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background Cerebral venous thrombosis is a rare cause of stroke that poses diagnostic, therapeutic, and prognostic challenges. Mainstay treatment is systemic anticoagulation, but endovascular treatment is increasingly advocated. Our objectives were to describe the epidemiology, treatment, and prognosis of 152 patients with cerebral venous thrombosis. Methods and Results This was a retrospective study of consecutive cerebral venous thrombosis cases from 2006 to 2013 at a comprehensive stroke center through hospital discharge. Predictors of full recovery (modified Rankin Scale scores 0–1) were analyzed with multiple logistic regression and presented as adjusted odds ratios (AORs) with 95% confidence intervals (CIs). The population was young (average age: 42 years), majority female (69%), and commonly presenting with cerebral edema (63%), and 72% were transferred in. All patients received systemic anticoagulation; 49% (n=73) required endovascular treatment. Reasons for requiring endovascular treatment included cerebral edema, herniation, or hemorrhagic infarct (n=38); neurologic decline (n=17); rethrombosis, persistent occlusion, or clot propagation (n=10); extensive clot burden (n=7); and persistent headache despite anticoagulation (n=1). There were 7 (10%) procedural complications. Recanalization was successful (61%), partial (30%), and unsuccessful (9%). Overall, 60% fully recovered. Positive predictors of full recovery included hormonal etiology, particularly for patients who were transferred in (AOR: 7.06 [95% CI, 2.27–21.96], interaction P=0.03) and who had migraine history (AOR: 4.87 [95% CI, 1.01–23.50], P=0.05), whereas negative predictors of full recovery were cerebral edema (AOR: 0.11 [95% CI, 0.04–0.34], P<0.001) and motor weakness (AOR: 0.28 [95% CI, 0.09–0.96], P=0.04). Conclusions As one of the largest cohort studies, our findings suggest that cerebral edema, history of migraine, and hormonal etiology were prognostic and that endovascular treatment might be a safe and effective treatment for cerebral venous thrombosis when conventional management is inadequate.
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Affiliation(s)
| | - Jeffrey Wagner
- Neurology Department, Swedish Medical Center, Englewood, CO
| | - Donald F Frei
- Neurology Department, Swedish Medical Center, Englewood, CO.,Radiology Imaging Associates, Englewood, CO
| | - David Loy
- Neurology Department, Swedish Medical Center, Englewood, CO.,Radiology Imaging Associates, Englewood, CO
| | - Richard J Bellon
- Neurology Department, Swedish Medical Center, Englewood, CO.,Radiology Imaging Associates, Englewood, CO
| | | | - Judd Jensen
- Neurology Department, Swedish Medical Center, Englewood, CO.,Blue Sky Neurology, Englewood, CO
| | - Christopher Fanale
- Neurology Department, Swedish Medical Center, Englewood, CO.,Blue Sky Neurology, Englewood, CO
| | - David Bar-Or
- Trauma Research Department, Swedish Medical Center, Englewood, CO
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24
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Mammen S, Keshava SN, Moses V, Aaron S, Ahmed M, Chiramel GK, Mani SE, Alexander M. Role of penumbra mechanical thrombectomy device in acute dural sinus thrombosis. Indian J Radiol Imaging 2017; 27:82-87. [PMID: 28515593 PMCID: PMC5385784 DOI: 10.4103/0971-3026.202956] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Background: In dural venous sinus thrombosis (DVST), the mortality ranges 5–30%. Deep venous system involvement and septic dural sinus thrombosis have a higher mortality rate. In acute occlusion, collateral flow may not be established, which may result in significant edema and mass effect. Endovascular interventions may be considered as a treatment option in appropriate high-risk patients with DVST. Materials and Methods: Eight patients with magnetic resonance imaging (MRI)-confirmed dural sinus thrombosis, who did not respond to the conventional standard medical treatment, were subsequently treated with mechanical thrombectomy using the Penumbra System®. In all cases, medical treatment including anticoagulants were continued following the procedure for a minimum period of 1 year. Results: Recanalization of the dural sinus thrombosis was achieved in all 8 cases. There were no immediate or late endovascular-related complications. One death occurred due to an unrelated medical event. At 6 months, there was notable improvement in the modified Rankin Score (mRS), with 5/8 (62%) patients achieving mRS of 2 or less. The follow-up ranged between 3 months and 26 months (mean: 14.5 months), and there were no new neurological events during the follow-up period. Conclusion: Cerebral venous sinus thrombosis is a rare but life-threatening condition that demands timely diagnosis and therapy. In cases of rapidly declining neurological status despite standard therapy with systemic anticoagulation and anti-edema measures, mechanical thrombectomy could be a lifesaving and effective option. In this study, good outcomes were observed in the majority of patients at long-term follow up.
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Affiliation(s)
- Suraj Mammen
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Vinu Moses
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sanjith Aaron
- Department of Neurology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Munawwar Ahmed
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - George K Chiramel
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sunithi E Mani
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Mathew Alexander
- Department of Neurology, Christian Medical College, Vellore, Tamil Nadu, India
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25
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Cabral de Andrade G, Lesczynsky A, Clímaco VM, Pereira ER, Marcelino PO, Franco AOC, De Almeida DF. Cerebral venous sinuses thrombosis in both transverse sinus and torcula: Multistep endovascular treatment and stenting. Interv Neuroradiol 2017; 23:84-89. [PMID: 27798328 PMCID: PMC5305158 DOI: 10.1177/1591019916674917] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Revised: 09/24/2016] [Accepted: 09/26/2016] [Indexed: 11/15/2022] Open
Abstract
Purpose Cerebral venous sinus thrombosis (CVST) is an unusual and potentially life-threatening condition with variable and nonspecific clinical symptoms and high morbimortality rates. Standard therapy consists of systemic anticoagulation; although there is no clear evidence about the best choice for treatment, intravenous heparin is used as the first-line treatment modality. Intravenous sinus thrombolysis can be an effective and relatively safe treatment for acutely deteriorating patients who have not responded to conventional therapy. This case report presents the possibility of endovascular treatment in multiple steps with mechanical thrombolysis with balloon, local pharmacological thrombolysis and stenting, in a patient with a severe form of CVST. Case summary A 67-year-old woman presented severe headache, agitation and confusion with diagnosis of venous sinus dural thrombosis in both lateral sinus and torcula. After 24 h there was neurological worsening evolving with seizures and numbness even after starting heparin, without sinus recanalization; CT scan showed left temporal intracerebral hemorrhage. We decided to take an endovascular approach in multiple steps. The first step was mechanical static thrombolysis with balloon; the second step was dynamic mechanical thrombolysis with a balloon partially deflated and "pulled"; the third step was local thrombolysis with Actilyse™; finally, the fourth step was angioplasty and reconstruction of the sinuses using multiple carotid stents and complete angiographic recanalization of both sinuses and torcula. After 24 h of endovascular treatment there was full clinical recovery and no tomographic complications. Conclusion This result shows that mechanical clot disruption, intrasinus thrombolysis and reconstruction of wall sinuses with stenting can be an endovascular option in the severe form of CVST with intracerebral hemorrhage and rapid worsening of neurological symptoms. Although this type of treatment can re-channel the occluded sinuses, further comparative and randomized studies are needed to clarify its efficacy versus other therapeutic modalities.
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Affiliation(s)
- G Cabral de Andrade
- CINN – Integrated Center of Neurology and Neurosurgery, Maringá, Brazil
- Parana Hospital, Maringá, Brazil
| | | | - VM Clímaco
- CINN – Integrated Center of Neurology and Neurosurgery, Maringá, Brazil
| | - ER Pereira
- CINN – Integrated Center of Neurology and Neurosurgery, Maringá, Brazil
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26
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Ma J, Shui S, Han X, Guo D, Li TF, Yan L. Mechanical thrombectomy with Solitaire AB stents for the treatment of intracranial venous sinus thrombosis. Acta Radiol 2016; 57:1524-1530. [PMID: 26953230 DOI: 10.1177/0284185116633912] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Cerebral venous sinus thrombosis (CVST) is a rare clinicopathological entity with substantial diagnostic and therapeutic dilemmas. The appropriate management of CVST remains to be defined. Purpose To evaluate the efficiency and safety of mechanical thrombectomy with Solitaire AB stents for the treatment of intracranial venous sinus thrombosis. Material and Methods Twenty-three consecutive patients with CVST who were treated with mechanical thrombectomy using Solitaire AB stents between January 2013 and October 2014 were retrospectively analyzed. The headache intensity was evaluated according to the visual analogue scale (VAS), and neurological function was assessed using the National Institute of Health Stroke Scale (NIHSS). Follow-up data were available for all patients for 6-14 months. Magnetic resonance imaging (MRI) and magnetic resonance venography (MRV) were performed at 3 and 6 months after neurointervention, and telephone interviews were performed monthly thereafter. The Wilcoxon signed-rank test was used to compare the evaluation data (VAS and NIHSS) at admission and discharge. Results Twenty-six Solitaire AB stents were used. No neurointervention-related complications were noted. The symptoms were significantly improved after neurointervention in all patients. The comparisons between the VAS and NIHSS evaluations at admission and discharge were significantly different ( P < 0.05). No recurrence was observed during the follow-up period. Conclusion Mechanical thrombectomy with Solitaire AB stents is safe and effective for the treatment of CVST and can significantly improve clinical symptoms. The occurrence of complications is low, and the prognosis is favorable.
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Affiliation(s)
- Ji Ma
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Shaofeng Shui
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
| | - XinWei Han
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Dong Guo
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Teng-Fei Li
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Lei Yan
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
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27
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Devasagayam S, Wyatt B, Leyden J, Kleinig T. Cerebral Venous Sinus Thrombosis Incidence Is Higher Than Previously Thought: A Retrospective Population-Based Study. Stroke 2016; 47:2180-2. [PMID: 27435401 DOI: 10.1161/strokeaha.116.013617] [Citation(s) in RCA: 199] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 06/06/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The incidence of cerebral venous thrombosis (CVT) varies between studies, but it is estimated to be between 2 and 5 per million per year. A recent study in the Netherlands with comprehensive ascertainment suggested a much higher incidence. It is uncertain whether these differing estimates reflect the quality of ascertainment or true variation. The purpose of this study was to determine the incidence of CVT in Adelaide, using a novel clinical and radiological methodology. METHODS We retrospectively identified CVT International Classification of Diseases-coded cases from all Adelaide public hospitals from 2005 to 2011. We also searched all neuroimaging studies (259 101) from these hospitals for text variations containing venous thromb. All potential cases were reviewed, and cases of incident CVT ascertained. Associations and outcomes were determined. RESULTS Of 169 possible cases, 105 cases of CVT were confirmed (59 cases by both coding and neuroimaging, 40 from neuroimaging alone, and 6 from coding alone). In our population of 953 390 adults, this represented an incidence of 15.7 million per year (95% confidence interval, 12.9-19.0), the highest incidence reported. Of these cases, a possible procoagulant predisposition was identified in 48%. Fifty-five of 105 cases occurred in females. Relative risk of CVT in females of reproductive age was insignificantly higher than in males (1.18 [95% confidence interval, 0.94-1.48]). CONCLUSIONS Cerebral venous sinus thrombosis in our study was more common than previously reported, perhaps because of more complete ascertainment. Future CVT incidence studies should include comprehensive capture and review of neuroimaging.
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Affiliation(s)
- Sharon Devasagayam
- From the Intensive Care Department, Royal Adelaide Hospital, Adelaide, SA, Australia (S.D.); Emergency Department, Flinders Medical Centre, Bedford Park, SA, Australia (B.W.); Neurology Department, Lyell McEwin Hospital, Elizabeth Vale, SA, Australia (J.L.); Neurology Department, Royal Adelaide, Lyell MCEwin Hospitals (T.K.); and Department of Medicine, University of Adelaide, Adelaide, SA, Australia (T.K.)
| | - Ben Wyatt
- From the Intensive Care Department, Royal Adelaide Hospital, Adelaide, SA, Australia (S.D.); Emergency Department, Flinders Medical Centre, Bedford Park, SA, Australia (B.W.); Neurology Department, Lyell McEwin Hospital, Elizabeth Vale, SA, Australia (J.L.); Neurology Department, Royal Adelaide, Lyell MCEwin Hospitals (T.K.); and Department of Medicine, University of Adelaide, Adelaide, SA, Australia (T.K.)
| | - James Leyden
- From the Intensive Care Department, Royal Adelaide Hospital, Adelaide, SA, Australia (S.D.); Emergency Department, Flinders Medical Centre, Bedford Park, SA, Australia (B.W.); Neurology Department, Lyell McEwin Hospital, Elizabeth Vale, SA, Australia (J.L.); Neurology Department, Royal Adelaide, Lyell MCEwin Hospitals (T.K.); and Department of Medicine, University of Adelaide, Adelaide, SA, Australia (T.K.)
| | - Timothy Kleinig
- From the Intensive Care Department, Royal Adelaide Hospital, Adelaide, SA, Australia (S.D.); Emergency Department, Flinders Medical Centre, Bedford Park, SA, Australia (B.W.); Neurology Department, Lyell McEwin Hospital, Elizabeth Vale, SA, Australia (J.L.); Neurology Department, Royal Adelaide, Lyell MCEwin Hospitals (T.K.); and Department of Medicine, University of Adelaide, Adelaide, SA, Australia (T.K.).
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28
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Manzoor NF, Ray A, Singer J, Nord R, Sunshine J, Megerian CA, Bambakidis NC, Semaan MT. Successful endovascular management of venous sinus thrombosis complicating trans-labyrinthine removal of vestibular schwanomma. Am J Otolaryngol 2016; 37:379-82. [PMID: 27045766 DOI: 10.1016/j.amjoto.2016.01.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 01/27/2016] [Indexed: 10/22/2022]
Abstract
Cerebral venous sinus thrombosis (CVST) is a rare complication of surgical treatment of vestibular schwanomma. We present a rare case of extensive venous sinus thrombosis after trans-labyrinthine approach that was refractory to systemic anti-coagulation. Mechanical aspiration thrombectomy was utilized to re-canalize the venous sinuses and resulted in successful resolution of neurological symptoms. Indications of utilizing endovascular approaches are discussed that will enable skull base surgeons to address this uncommon yet potentially fatal complication.
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29
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30
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Moore J, Thomas P, Cousins V, Rosenfeld JV. Diagnosis and Management of Dural Sinus Thrombosis following Resection of Cerebellopontine Angle Tumors. J Neurol Surg B Skull Base 2014; 75:402-8. [PMID: 25452898 DOI: 10.1055/s-0034-1376421] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 03/24/2014] [Indexed: 10/25/2022] Open
Abstract
Objective Lateral sinus thrombosis is a potentially devastating but seldom studied complication of cerebellopontine angle (CPA) tumor surgery. Systemic anticoagulation in the early postoperative period has often been avoided due to the potential risks of intracranial hemorrhage. Design Retrospective review. Setting Tertiary referral center. Main Outcome Measures The goal of this study was to identify the frequency, treatment, and outcomes in patients who develop postoperative venous sinus thrombosis following CPA tumor surgery and receive early systemic anticoagulation. Results Of 43 patients with CPA tumors, we report five patients (11.6%) with transverse and/or sigmoid sinus thrombosis following resection of the tumor, four of which were detected on routine early postoperative noncontrast computed tomography (CT) scan. The thrombosis was confirmed in all cases with CT venography or magnetic resonance venography. Affected patients had significantly larger tumors than controls and tended to undergo longer operations. These patients were treated with immediate anticoagulation (intravenous heparin, followed by Coumadin for 6 months) without complication. Conclusion Venous sinus thrombosis is an underrecognized complication of CPA surgery, but it can be diagnosed in the early postoperative period by noncontrast CT imaging. Early postoperative initiation of systemic anticoagulation appears safe and effective to prevent the progression of thrombosis and its consequences.
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Affiliation(s)
- Justin Moore
- Department of Neurosurgery, The Alfred Hospital, Melbourne, Australia
| | - Piers Thomas
- Department of Neurosurgery, The Alfred Hospital, Melbourne, Australia
| | - Vincent Cousins
- Department of Ear Nose and Throat Surgery, The Alfred Hospital, Melbourne, Australia ; Department of Surgery, Monash University, Australia
| | - Jeffrey V Rosenfeld
- Department of Neurosurgery, The Alfred Hospital, Melbourne, Australia ; Department of Surgery, Monash University, Australia
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Decompressive Surgery for Malignant Cerebral Venous Sinus Thrombosis: A Retrospective Case Series from Pakistan and Comparative Literature Review. J Stroke Cerebrovasc Dis 2014; 23:e13-22. [DOI: 10.1016/j.jstrokecerebrovasdis.2013.07.045] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 07/26/2013] [Accepted: 07/31/2013] [Indexed: 11/22/2022] Open
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32
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Friedman DI. Secondary Headache Disorders Encountered in Clinical Practice. Headache 2013. [DOI: 10.1002/9781118678961.ch3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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33
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Riordan MA, Deshaies EM. Two cases of venous sinus thrombosis in women taking the oral contraceptive pill, Yaz (dropirenone/ ethinyl estradiol), and review of the literature. Health (London) 2013. [DOI: 10.4236/health.2013.57a4013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Periorbital cellulitis, subgaleal abscess and superior sagittal sinus thrombosis: a rare combination of complications arising from unilateral frontal sinusitis. The Journal of Laryngology & Otology 2012; 126:1281-3. [DOI: 10.1017/s0022215112002228] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
AbstractBackground:Subclinical infection of the sinuses can result in delayed diagnosis and unusual presenting complications.Case report:This paper describes the case of a 14-year-old boy with a rare combination of periorbital cellulitis, subgaleal abscess and superior sagittal sinus thrombosis following a late presentation of unilateral frontal sinusitis.Results:Following multiple surgical procedures, and antimicrobial and anticoagulation therapy, the patient made a full recovery.Conclusion:Serious sinusitis complications still occur, and can do so in unusual combinations with minimal clinical signs. Systemic anticoagulation therapy is considered safe practice in the management of cerebral venous sinus thrombosis and may reduce morbidity and mortality.
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Singleton RH, Jankowitz BT, Wecht DA, Gardner PA. Iatrogenic cerebral venous sinus occlusion with flowable topical hemostatic matrix. J Neurosurg 2011; 115:576-83. [DOI: 10.3171/2011.3.jns10881] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The use of commercially available topical hemostatic adjuncts has increased the safety profile of surgery as a whole. Cranial surgery has also benefited from the development of numerous agents designed to permit more rapid achievement of hemostasis. Flowable topical hemostatic agents applied via syringe injection are now commonly employed in many neurosurgical procedures, including cranial surgery. Intravascular use of these strongly thrombogenic agents is contraindicated, but in certain settings, inadvertent intravascular administration can occur, resulting in vascular occlusion, thrombosis, and potential dissemination. To date, there have no reports detailing the presence and incidence of this complication.
Methods
The authors conducted a retrospective review of all cranial surgeries performed at Presbyterian University Hospital by members of the University of Pittsburgh Medical Center's Department of Neurological Surgery between 2007 and 2009. Cases complicated by vascular occlusion due to inadvertent intravascular administration of flowable topical hemostatic matrix (FTHM) were identified and analyzed.
Results
Iatrogenic vascular occlusion induced by FTHM was identified in 5 (0.1%) of 3969 cranial surgery cases. None of these events occurred in 3318 supratentorial cases, whereas 5 cases of cerebral venous sinus occlusion occurred in 651 infratentorial cases (0.8%). The risk of accidental vessel occlusion was significantly associated with infratentorial surgery, and all events occurred in the transverse and/or sigmoid sinus. No episodes of inadvertent vascular occlusion occurred during endoscopic surgery. No cases of arterial occlusion were identified. Of the 5 patients with FTHM-related cerebral venous sinus occlusion, none developed long-term neurological sequelae referable to the event.
Conclusions
Inadvertent intravascular administration of FTHM is a rare complication associated with cranial surgery that occurs most commonly during infratentorial procedures around the transverse and/or sigmoid sinuses. Modifications in the choice of when to use an FTHM and the method of application may help prevent accidental venous sinus administration.
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Delay in diagnosis of cerebral venous and sinus thrombosis: successful use of mechanical thrombectomy and thrombolysis. Case Rep Med 2011; 2011:815618. [PMID: 21776277 PMCID: PMC3138110 DOI: 10.1155/2011/815618] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Accepted: 06/09/2011] [Indexed: 12/28/2022] Open
Abstract
Cerebral venous and sinus thrombosis is a relatively rare condition with a variable presentation that can translate into a difficult workup and a delay in diagnosis and treatment. We describe the successful use of mechanical thrombectomy and thrombolysis in the case of an eighteen-year-old woman that presented with progressive thrombosis of the jugular veins and dural sinuses despite adequate anticoagulation. Our case highlights the need for clinicians to include CVST in the initial differential diagnosis of patients in order to prevent delays and poor outcomes.
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Abstract
Acute neurological diseases requiring hospitalization are relatively rare in women of childbearing age. However, during pregnancy and the postpartum period, several diseases increase in prevalence. Some are unique to the pregnant/postpartum state including preeclampsia and delivery-associated neuropathies. Others, although indirectly related to pregnancy, such as cerebral venous thrombosis, ischemic stroke, and intracerebral hemorrhage, increase in frequency and carry considerable risk of morbidity and mortality. In addition, treatment options are often limited. This review discusses the diseases more commonly seen during pregnancy and the postpartum period, with a focus on emergent neurological diseases and their management. Interventional therapies will also be discussed.
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Affiliation(s)
| | - Louise D. McCullough
- Hartford Hospital Stroke Center, Hartford CT, USA
- The University of Connecticut Health Center, Farmington, CT, USA
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38
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Hanzelka KM, Zalpour A, Afshar-Kharghan V, Fitousis K, Anderlini P, Yeung SCJ. Severe thrombosis and acute thrombocytopenia in a cancer patient. Am J Hematol 2010; 85:887-90. [PMID: 20721891 DOI: 10.1002/ajh.21808] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Katy M Hanzelka
- Division of Pharmacy-Pharmacy Clinical Programs, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA
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