Postoperative cerebral venous sinus thrombosis in the setting of surgery adjacent to the major dural venous sinuses

Abstract

OBJECTIVECerebral 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.METHODSA 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.RESULTSTwenty-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).CONCLUSIONSThis 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.

Tentorial Venous Anatomy: Variation in the Healthy Population

“…6,17 Further, our study may aid in determining which patients with postoperative venous sinus thrombosis remain asymptomatic or resolve spontaneously versus which require intervention. 7 Knowledge of the transtentorial venous system is critical to neuroradiologists guiding neurosurgeons in surgical planning of skull base approaches. Further, this anatomy will enable prompt neuroradiologic recognition of surgical complications.…”

“…However, tentorial sectioning may still produce unexplained adverse consequences. 6,7 Several cadaveric and radiographic studies previously demonstrated the anatomic patterns of bridging veins to the tentorium and medial and lateral venous sinuses within the tentorium. [8][9][10][11] A recent study found a relationship between the anatomy of the tentorial sinuses at the transverse-sigmoid junction and cranial morphometrics.…”

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

“…While earlier studies reported a rate of typically less than 5%, more contemporary reports are in agreement that the actual postoperative rate of DVST is closer to 20 to 30%. 4,[15][16][17][18] In our cohort of patients, the overall rate of postoperative DVST based only on initial imaging reports was 9.52%. After review of the postoperative imaging for this study, we found that DVST went undiagnosed in 16 patients.…”

The interhemispheric fissure—surgical outcome of interhemispheric approaches

“…Especially in case of asymptomatic patients, we experienced no need of extensive postoperative heparinization. Recent retro-and prospective studies also showed higher radiographic incidence of postoperative cerebral venous sinus thrombosis than reported in retrospective studies [10,22,29,30]. They also advocated conservative treatment in absence of symptoms; collateral venous drainage is discussed as one of the main mechanisms for well thrombosis tolerance.…”