Cerebral venous thrombosis: an unexpected complication from spinal surgery

Costa, Bruno Lourenço; Shamasna, Motasem; Nunes, Joana; Magalhães, Florbela; Peliz, António Júdice

doi:10.1007/s00586-013-3147-0

Cited by 12 publications

(5 citation statements)

References 32 publications

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“…No study has investigated the incidence of iatrogenic CVT following surgery. There have been case reports of CVT after applying topical hemostatic matrix and cauterization at the nearby sinus, as well as studies on the incidence at the remote site after lumbar CSF drainage13,19). In our study group, all of the seven cases displayed localized CVT near the surgical lesion, which implies iatrogenic injury to these sinuses.…”

Section: Discussionmentioning

confidence: 59%

Clinical Characteristics of Cerebral Venous Thrombosis in a Single Center in Korea

Park

Moon

Chun

et al. 2014

J Korean Neurosurg Soc

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ObjectiveThe purpose of this study is to investigate the clinical characteristics of cerebral venous thrombosis (CVT) in a single center in Korea.MethodsA total of 36 patients were diagnosed with CVT from August 2005 to May 2013. The patient data regarding age, sex, disease stage, pathogenesis, location, laboratory findings, radiological findings, and treatment modalities were retrospectively collected. The results were compared with those of previous studies in other countries.ResultsThe patient group comprised 21 men and 15 women with a mean age of 46.9 years (ranging from three months to 77 years). The most common cause was a prothrombotic condition (8 patients, 22.2%). Within the patient group, 13 patients (36.1%) had a hemorrhagic infarction, whereas 23 (63.9%) had a venous infarction without hemorrhage. By location, the incidence of hemorrhagic infarction was the highest in the group with a transverse and/or sigmoid sinus thrombosis (n=9); however, the proportion of hemorrhagic infarction was higher in the cortical venous thrombosis group (75%) and the deep venous thrombosis group (100%). By pathogenesis, the incidence of hemorrhagic infarction was the highest in the prothrombotic group (n=6), which was statistically significant (p=0.016).ConclusionAccording to this study, CVT was more prevalent in men, and the peak age group comprised patients in the sixth decade. The most common cause was a prothrombotic condition. This finding was comparable with reports from Europe or America, in which CVT was more common in younger women. Hemorrhagic infarction was more common in the prothrombotic group (p=0.016) than in the non-prothrombotic group in this study.

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Section: Discussionmentioning

confidence: 59%

Clinical Characteristics of Cerebral Venous Thrombosis in a Single Center in Korea

Park

Moon

Chun

et al. 2014

J Korean Neurosurg Soc

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“…Traditionally, the prognosis is poor for a majority of patients with CVT 1)4)6)10)17)20). However, the ISCVT cites a mortality rate at discharge of only 4.3%, and a recent systematic review of CVT showed that the mortality of patients with CVT has substantially declined over time, owing to better treatments, a shift in risk factors, and (most importantly) heightened detection of less critical disease through improved diagnostics 6)13)14)15)30)34)35)…”

Section: Discussionmentioning

confidence: 99%

Clinical Aspects of Cerebral Venous Thrombosis: Experiences in Two Institutions

Rim

Jun

Ahn

et al. 2016

J Cerebrovasc Endovasc Neurosurg

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ObjectiveCerebral venous thrombosis (CVT) is a rare condition for which few clinical reviews have been conducted in Korea. Our aim was to investigate, risk factors, clinical presentations/courses, and outcomes of 22 patients treated for CVT at two centers.Materials and MethodsA retrospective analysis was conducted, selecting 22 patients diagnosed with and treated for CVT at two patient care centers over a 10-year period (January 1, 2004 to August 31, 2015). Patient data, pathogenetic concerns (laboratory findings), risk factors, locations, symptoms, treatments, and clinical outcomes were reviewed.ResultsMean patient age at diagnosis was 54.41 ± 16.19. Patients most often presented with headache (40%), followed by seizure (27%) and altered mental status (18%). Focal motor deficits (5%), visual symptoms (5%), and dysarthria (5%) were less common. Important predisposing factors in CVT included prothrombotic conditions (35%), infections (14%), hyperthyroidism (18%), trauma (14%), and malignancy (4%). By location, 9 patients (40%) experienced thrombosis of superior sagittal sinus predominantly, with involvement of transverse sinus in 20 (90%), sigmoid sinus in 12 (40%), and the deep venous system in 5 (23%). Treatment generally consisted of anticoagulants (63%) or antiplatelet (23%) drugs, but surgical decompression was considered if warranted (14%). Medical therapy in CVT yields good functional outcomes.ConclusionMean age of patients with CVT in our study exceeded that reported in Europe or in America and had difference in risk factors. Functional outcomes are good with use of antithrombotic medication, whether or not hemorrhagic infarction is evident.

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“…[ 2 ] Ventriculoperitoneal shunting or spinal surgery was reported as causes of CVT. [ 3 4 ] Intracranial hypotension (IH) induced by decreased CSF is hypothesized to damage of cerebral veins by stretching and dilation, thus triggering CVT.…”

Section: Discussionmentioning

confidence: 99%

“…[ 10 ] According to the Monro–Kellie doctrine, a decrease in CSF volume and subsequent IH cause venous congestion and can secondarily lead to venous infarction or CVT. [ 4 6 8 13 14 ] It is reported that outflow impairment occurs mainly in the great cerebral vein as it enters the tentorial sinus. [ 13 ] The endothelial cell injury revealed in the autopsy of case 2 may have been induced by IH.…”

Section: Discussionmentioning

confidence: 99%

Intracranial hypotension-associated cerebral swelling following cranioplasty: Report of two cases

et al. 2017

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Cranioplasty is a comparatively simple neurosurgical procedure, and fatal complications are rare. This report describes two cases of critical brain swelling after otherwise uneventful cranioplasty. Both cases had subarachnoid hemorrhage and extremely similar clinical courses. They underwent decompressive craniotomy and clipping in the acute phase and had cranioplasty in the chronic phase, resulting in serious cerebral swelling and death. Deep venous sinus thrombosis was revealed in the autopsy for one case. Although no venous occlusion was identified in the other case, radiological findings suggested venous congestion. In both cases, intraoperative cerebrospinal fluid leakage was massive and was prolonged by a drain; therefore, we hypothesized that intracranial hypotension (IH) caused stagnation of venous flow. Neurosurgeons should be aware that fatal venous congestion induced by IH may occur after cranioplasty. To avoid this, tight dural closure should be obtained, and avoidance of the use of subcutaneous drains should be considered.

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Cerebral venous thrombosis: an unexpected complication from spinal surgery

Cited by 12 publications

References 32 publications

Clinical Characteristics of Cerebral Venous Thrombosis in a Single Center in Korea

Clinical Characteristics of Cerebral Venous Thrombosis in a Single Center in Korea

Clinical Aspects of Cerebral Venous Thrombosis: Experiences in Two Institutions

Intracranial hypotension-associated cerebral swelling following cranioplasty: Report of two cases

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