Asymptomatic Postoperative Cerebral Venous Sinus Thrombosis After Posterior Fossa Tumor Surgery: Incidence, Risk Factors, and Therapeutic Options

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.

Diagnosis and Management of Cerebral Venous Thrombosis: A Scientific Statement From the American Heart Association

“…1,4 Mechanical provoking factors such as head trauma, neurosurgical procedures, and compressive lesions such as meningiomas impinging on venous sinuses are also associated with CVT. 1,4,21…”

“…Women with a history of VTE appear to have an increased risk of thrombotic events (ie, deep venous thrombosis, pulmonary embolism) in future pregnancies. 64 A systematic review comprising 17 studies and 393 pregnancies found a recurrence rate of 8 per 1000 pregnancies (95% CI, [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]. The rate of noncerebral VTEs was 22 per 1000 pregnancies (95% CI, 11-43).…”

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

“…Patients undergoing posterior fossa surgery for cerebellopontine angle tumors are largely retained at increased risk for the development of CVST [1,2,15,21].…”

“…Besides to be a spontaneous event in several systemic conditions such as infection, malignancies, hematologic disorders, trauma, etc., cerebral venous sinus thromboses (CVST) can be also complications of neurosurgical interventions, especially in case of lesions or surgical approaches involving the dural sinuses with a reported incidence estimated between 5% and 12% [3,6,15,21].…”

“…However, post-surgical CVSTs frequently appear segmental and not progressive, therefore apparently they do not seem sharing the same natural history of the spontaneous forms, even though they can present similar pathophysiological mechanisms. In fact, postoperative CVSTs often remain clinically silent [21], and only a small percentage of patients become symptomatic depending on thrombosis extension and compensation effectiveness of the collateral venous drainage supply [3,13].…”