Dural sinus thrombosis and pseudotumor cerebri: unexpected complications of suboccipital craniotomy and translabyrinthine craniectomy

Abstract

First, the status of the transverse and sigmoid sinuses should be documented using MR venography before patients undergo posterior fossa surgery. Second, thrombosis of a transverse or sigmoid sinus may not be tolerated even if the sinus is nondominant; vision-threatening pseudotumor cerebri may result. Third, MR venography is a reliable, noninvasive means of evaluating the venous sinuses. Fourth, if the diagnosis is made shortly after thrombosis, then direct endovascular thrombolysis with urokinase may be a therapeutic option. If the presentation is delayed, then ophthalmological complications of pseudotumor cerebri can be avoided by administration of a combination of acetazolamide, dexamethasone, lumbar puncture, and possibly lumboperitoneal shunt placement.

Complete Superior and Inferior Sagittal Sinus Thromboses With Multiple Cranial Nerve Pareses and Transient Ischemic Attack. Case Report.

“…Aseptic (primary) intracranial venous occlusive disease tends to favor unpaired sinuses and is associated with pregnancy and puer-Sinus Thromboses With Multiple Cranial Nerve Pareses and TIA perium, malignancy, hypercoagulable state (thrombophilia), lupus erythematosus, Behçet's disease, familial Mediterranean fever, oral contraceptives, intracranial surgery, trauma, dehydration, cachexia, cardiac diseases, diabetes mellitus, and homocysteinuria. 2,6,9,12) In our case, no etiological factor could be found. The ratio of women to men is 2:1.…”

“…The clinical manifestations of superior sagittal sinus (SSS) thrombosis are nonspecific but characterized by the symptoms of either isolated intracerebral hemorrhage (ICH), i.e., headache, papilledema, blurred vision, 2,9,12,16) or ICH symptoms together with seizures, focal deficits, progressive coma, and death. 6,10,12,14) Sporadic cases of cranial nerve pareses associated with SSS thrombosis are rare, 1,4,6,15) and only three cases with transient ischemic attack (TIA) have been reported since 1966.…”

Postoperative Imaging Findings following Sigmoid Sinus Wall Reconstruction for Pulse Synchronous Tinnitus

“…Manipulation of the sigmoid sinus wall entails a risk for thrombosis, and sigmoid sinus thrombosis is not infrequently encountered following translabyrinthine and suboccipital craniectomy. 16 Although the surgical technique used in this study does not require significant exposure or retraction of the sigmoid sinus, the risk for thrombosis does exist. To avoid this, all patients at our institution are placed on an anticoagulation regimen comprising aspirin preoperatively and aspirin and clopidogrel postoperatively.…”

Postoperative imaging of vestibular schwannomas

“…21 Venous sinus thrombosis has been reported in up to 5% of suboccipital craniotomies and translabyrinthine craniectomies for tumor resection. 10 The transverse and sigmoid sinuses on the treated side are most often affected, while the contralateral sinuses are typically spared. Magnetic resonance imaging with MRV is a suitable, noninvasive modality for obtaining the diagnosis (Fig.…”

“…Patients can present with headache, visual obscuration, and papilledema due to elevated intracranial pressure, even if the affected venous sinus is nondominant. 10 Symptomatic treatment consists of acetazolamide and steroids; however, endovascular thrombolysis or anticoagulation may be warranted in the acute postoperative period. 10 Postoperative hemorrhage can result from venous injury and occurs in approximately 0.6% of cases.…”