The role of anticoagulation for superior sagittal sinus thrombosis following craniotomy for resection of parasagittal/parafalcine meningiomas

Jimenez, Adrian E.; Khalafallah, Adham M.; Botros, David; Horowitz, Melanie A.; Azmeh, Omar; Lam, Sharon; Oliveira, Leonardo A.P.; Chakravarti, Sachiv; Liu, Sophie; Wu, Esther; Wei, Oren; Porras, Jose L.; Bettegowda, Chetan; Tamargo, Rafael J.; Brem, Henry; Mukherjee, Debraj

doi:10.1007/s11060-021-03916-2

Cited by 4 publications

(3 citation statements)

References 31 publications

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“…More recently, Jimenez et al reported a large series of patients treated for parasagittal/parafalcine meningiomas presenting with post-surgical SSS thrombosis. They reported about 5.6% of CVST incidence, but symptoms in only 1.9% of patients [9]. However, our case series collected through a careful retrospective radiological review also of the asymptomatic cases shows that supratentorial CVST is not so rare.…”

Section: Supratentorial Cvstmentioning

confidence: 49%

Post-operative segmental cerebral venous sinus thrombosis: risk factors, clinical implications and therapeutic considerations.

Sturiale

Auricchio

Valente

et al. 2023

Preprint

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Background Cerebral venous sinus thromboses (CVSTs) are rare complications of neurosurgical interventions and their management remains controversial as most of cases appears clinically silent. Here, we analyzed our institutional series of patients with CVSTs evaluating clinical and neuroradiological characteristics, risk factors, and outcome. Materials and methods 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. Results 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 was observed in about 88% of patients at follow-up. Conclusions 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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Section: Supratentorial Cvstmentioning

confidence: 49%

Post-operative segmental cerebral venous sinus thrombosis: risk factors, clinical implications and therapeutic considerations.

Sturiale

Auricchio

Valente

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

“…More recently, Jimenez et al reported a large series of patients treated for parasagittal/parafalcine meningiomas presenting with post-surgical SSS thrombosis. They reported about 5.6% of CVST incidence, but symptoms in only 1.9% of patients [ 14 ]. However, our case series collected through a careful retrospective radiological review also of the asymptomatic cases shows that supratentorial CVST is not so rare.…”

Section: Discussionmentioning

confidence: 99%

Post-operative segmental cerebral venous sinus thrombosis: risk factors, clinical implications, and therapeutic considerations

et al. 2023

View full text Add to dashboard Cite

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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“…Cerebral venous sinus thrombosis can occur as a manifestation of the systemic hypercoagulability in brain tumor patients – albeit much more rarely than DVT or PE [2] – in which case the thrombosis may manifest in a distant location from the tumor [34]; or, more frequently, it may happen in the context of tumor invasion of the venous sinuses. Most of these cases are related to invasion of the sinuses by a meningioma, in particular of the superior sagittal sinus (SSS) by a parasagittal or falcine tumor; although meningiomas in this location cause partial or total occlusion of the SSS in over half of cases [35], due to their slow-growing nature this is typically asymptomatic. Frank thrombosis (as opposed to tumor invasion without an associated clot) can be seen as a complication after surgical resection of these tumors, rather than spontaneously, and may or may not be symptomatic; its optimal management is unclear, and observation rather than anticoagulation may be a reasonable approach (especially in asymptomatic cases), although further studies are needed [35].…”

Section: Local Complicationsmentioning

confidence: 99%

Vascular complications in patients with brain tumors

Díaz

Schiff

2022

Current Opinion in Oncology

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Purpose of reviewVenous thromboembolism (VTE) and other vascular events are common in patients with brain tumors, but their optimal management is not firmly established, in large part due to the competing risk of intracranial hemorrhage (ICH) in this population.Recent findingsThere is conflicting evidence on whether therapeutic anticoagulation increases the risk of ICH in patients with brain tumors, with several metanalysis and retrospective cohort studies showing an increased risk and others showing no differences. Current guidelines recommend anticoagulating brain tumors patients with VTE with either low-molecular weight heparin (LMWH) or direct oral anticoagulants (DOACs), and several retrospective studies have shown the risk of ICH with DOACs is similar or smaller than with LMWH.SummaryAn increased risk of VTE exists in a variety of brain tumor types. Most patients with brain tumors and VTE should receive therapeutic anticoagulation, and recent retrospective evidence supports the use of both LMWH and DOACs as effective and relatively safe in this setting. Patients with brain tumors are also at increased risk of other vascular tumor- or treatment-related complications whose optimal management is unclear.

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The role of anticoagulation for superior sagittal sinus thrombosis following craniotomy for resection of parasagittal/parafalcine meningiomas

Cited by 4 publications

References 31 publications

Post-operative segmental cerebral venous sinus thrombosis: risk factors, clinical implications and therapeutic considerations.

Post-operative segmental cerebral venous sinus thrombosis: risk factors, clinical implications and therapeutic considerations.

Post-operative segmental cerebral venous sinus thrombosis: risk factors, clinical implications, and therapeutic considerations

Vascular complications in patients with brain tumors

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