Hydrocephalus in cerebral venous thrombosis

Zuurbier, Susanna M.; Berg, René van den; Troost, Dirk; Majoie, Charles B. L. M.; Stam, Jan; Coutinho, Jonathan M.

doi:10.1007/s00415-015-7652-4

Cited by 30 publications

(14 citation statements)

References 17 publications

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“…12 Zuurbier et al reported a 15.1% incidence of hydrocephalus secondary to a spontaneous cerebral sinus thrombosis. 16 In the present study, hydrocephalus, requiring internal CSF diversion but not leading to permanent impairment, appeared in 2 of 12 patients (16.7%) with a postoperative lateral sinus thrombosis. However, the exact origin of the hydrocephalus is a matter of debate during the early postoperative period because the underlying disease, surgical procedure, and location of the lesion may equally account for it.…”

Section: Consequences Of Postoperative Lateral Sinus Thrombosissupporting

confidence: 42%

Presentation and management of lateral sinus thrombosis following posterior fossa surgery

Apra

Kotbi

Turc

et al. 2017

JNS

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OBJECTIVE There are no guidelines for the management of postoperative lateral sinus thrombosis following posterior fossa surgery. Introducing treatment-dose anticoagulant therapy during the immediate postoperative period increases the risk of intracranial bleeding. This study assessed the incidence of and risk factors associated with postoperative lateral sinus thrombosis and the complications related to thrombosis and/or anticoagulation. METHODS This study was a retrospective monocentric analysis of adult patients who underwent surgical removal of a posterior fossa space-occupying lesion with available postoperative imaging. Postoperative lateral sinus thrombosis was defined as a T2 hypointensity within the venous sinus and/or a filling defect on postcontrast MRI or CT scan. RESULTS Among 180 patients, 12 (6.7%; 95% CI 3.0-10.4) were found to have lateral sinus thrombosis on postoperative imaging, none of whom were symptomatic. Unadjusted risk factors for postoperative lateral sinus thrombosis were a history of deep venous thrombosis (p = 0.016), oral contraceptive pill (p = 0.004), midline surgical approach (p = 0.035), and surgical exposure of the sinus (p < 0.001). Seven of the patients (58.3%) with a postoperative lateral sinus thrombosis received immediate treatment-dose anticoagulant therapy. Lateral sinus recanalization occurred radiologically at a mean time of 272 ± 23 days in 85.7% of patients (6 of 7) undergoing treatment-dose anticoagulant therapy and in 20% of patients (1 of 5) not receiving treatment-dose anticoagulant therapy. Postoperative complications occurred in 56.2% of patients (9 of 16) who received treatment-dose curative anticoagulant therapy and in 27% of patients (45 of 164) who did not. CONCLUSIONS Incidental radiological lateral sinus thrombosis following posterior fossa surgery has an incidence of 6.7%. To further define the benefit-to-risk ratio of a treatment-dose anticoagulant therapy, a prospective trial should be considered.

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Section: Consequences Of Postoperative Lateral Sinus Thrombosissupporting

confidence: 42%

Presentation and management of lateral sinus thrombosis following posterior fossa surgery

Apra

Kotbi

Turc

et al. 2017

JNS

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“…[1][2][3] Several studies have examined common post-operative complications of VS tumor resections, such as cranial nerve function, infection, and cerebrospinal fluid (CSF) leaks. 4,5 The incidence of these complications is typically compared with various factors including demographics, surgical approach, and operative time. 4,6 However, there is limited data on the incidence, clinical progression, and proper management of potentially fatal dural venous sinus thrombosis (DVST) after VS tumor resections.…”

Section: Introductionmentioning

confidence: 99%

Dural Venous Sinus Thrombosis after Vestibular Schwannoma Surgery: The Anticoagulation Dilemma

Brahimaj

Beer‐Furlan

Crawford

et al. 2019

J Neurol Surg B Skull Base

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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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“…122 In a recent case series of 14 CVT patients with acute hydrocephalus only one patient had a shunt. 121 Despite shunting the patient died.…”

Section: (Recommendations)mentioning

confidence: 99%

“…Mild ventricular enlargement can be found in thrombosis of the deep venous system due to thalamic oedema and in the contralesional side in CVT complicated by large hemispherical lesions. 121 In the literature review we found 736 titles, from which we selected 30 full text articles and included 10 studies. Studies were case reports, case series and a systematic review of cases.…”

Section: (Recommendations)mentioning

confidence: 99%

European Stroke Organization guideline for the diagnosis and treatment of cerebral venous thrombosis – Endorsed by the European Academy of Neurology

Ferro

Bousser

Canhão

et al. 2017

European Stroke Journal

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170

103

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The current proposal for cerebral venous thrombosis guideline followed the Grading of Recommendations, Assessment, Development, and Evaluation system, formulating relevant diagnostic and treatment questions, performing systematic reviews of all available evidence and writing recommendations and deciding on their strength on an explicit and transparent manner, based on the quality of available scientific evidence. The guideline addresses both diagnostic and therapeutic topics. We suggest using magnetic resonance or computed tomography angiography for confirming the diagnosis of cerebral venous thrombosis and not screening patients with cerebral venous thrombosis routinely for thrombophilia or cancer. We recommend parenteral anticoagulation in acute cerebral venous thrombosis and decompressive surgery to prevent death due to brain herniation. We suggest to use preferentially low-molecular weight heparin in the acute phase and not using direct oral anticoagulants. We suggest not using steroids and acetazolamide to reduce death or dependency. We suggest using antiepileptics in patients with an early seizure and supratentorial lesions to prevent further early seizures. We could not make recommendations due to very poor quality of evidence concerning duration of anticoagulation after the acute phase, thrombolysis and/or thrombectomy, therapeutic lumbar puncture, and prevention of remote seizures with antiepileptic drugs. We suggest that in women who suffered a previous cerebral venous thrombosis, contraceptives containing oestrogens should be avoided. We suggest that subsequent pregnancies are safe, but use of prophylactic low-molecular weight heparin should be considered throughout pregnancy and puerperium. Multicentre observational and experimental studies are needed to increase the level of evidence supporting recommendations on the diagnosis and management of cerebral venous thrombosis. KeywordsCerebral venous thrombosis, dural sinus thrombosis, Grading of Recommendations, Assessment, Development, and Evaluation, angiography, venography, D dimers, prothrombotic screening, cancer screening, anticoagulation, heparin, thrombolysis, thrombectomy, acetazolamide, steroids, decompressive surgery, hemicraniectomy, lumbar puncture, shunt, pregnancy, puerperium, contraception, antiepileptic drugs These guidelines followed the traditional methodology of combining review of scientific evidence with expert opinion and classifying evidence and recommendations in complex grading systems, using a matrix combining classes of recommendations with levels of evidence.Since 2010-2011 new information has accumulated on multiple aspects of the diagnosis and management of CVT. We aim to update previous EFNS guidelines using a clearer and evidence base methodology. To achieve that aim, the current proposal for CVT guidelines followed the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system, 3 formulating relevant diagnostic and treatment questions, performing systematic reviews of all available eviden...

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Hydrocephalus in cerebral venous thrombosis

Cited by 30 publications

References 17 publications

Presentation and management of lateral sinus thrombosis following posterior fossa surgery

Presentation and management of lateral sinus thrombosis following posterior fossa surgery

Dural Venous Sinus Thrombosis after Vestibular Schwannoma Surgery: The Anticoagulation Dilemma

European Stroke Organization guideline for the diagnosis and treatment of cerebral venous thrombosis – Endorsed by the European Academy of Neurology

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