Dural venous sinus thrombosis after cerebellopontine angle surgery: Should it be treated?

Kow, Chien Yew; Caldwell, James R.; McHugh, F.; Sillars, Hamish A.; Bok, Arnold

doi:10.1016/j.jocn.2019.12.036

Cited by 10 publications

(7 citation statements)

References 9 publications

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“…Post-operative non-invasive imaging (either MRV or CTV) has been used to assess sigmoid sinus patency when compromise is suspected ( 4 , 6 ), such as in patients complaining of symptoms of elevated intracranial pressure including headache and CSF leak. Recent studies have shown that the incidence of post-operative stenosis of the lateral sinus following translabyrinthine surgery may be higher than previously thought ( 2 ). The clinical significance of asymptomatic post-operative stenosis of sigmoid sinus following lateral skull base surgery, however, is not established, especially with regard to whether or not prophylactic anti-coagulation is required in the presence of an asymptomatic stenosis ( 1 , 2 ).…”

Section: Discussionmentioning

confidence: 99%

“…Recent studies have shown that the incidence of post-operative stenosis of the lateral sinus following translabyrinthine surgery may be higher than previously thought ( 2 ). The clinical significance of asymptomatic post-operative stenosis of sigmoid sinus following lateral skull base surgery, however, is not established, especially with regard to whether or not prophylactic anti-coagulation is required in the presence of an asymptomatic stenosis ( 1 , 2 ). In our opinion, the need for anti-coagulation also depends on the presumptive etiology of the stenosis: stenosis, or even occlusion, due to external compression of the sinus can be treated more expectantly as there is presumably little or no risk of clot propagation within the sinus, whereas thrombosis caused by damaged endothelium may result in a higher risk of morbidity.…”

Section: Discussionmentioning

confidence: 99%

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The Role of Intra-Operative Duplex Ultrasonography Following Translabyrinthine Approach for Vestibular Schwannoma

et al. 2022

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ObjectiveSigmoid sinus (SS) stenosis is a complication of translabyrinthine approach. Velocity changes in the SS measured by intra-operative doppler ultrasound may help in identifying patients at risk for sinus occlusion.PatientsSS velocity was measured using doppler ultrasound prior to opening dura and again prior to placement of the abdominal fat graft.InterventionData collected included: patient age, surgical side, sinus dominance, tumor volume, intra-operative doppler ultrasound measurements, post-operative venous sinus imaging, anticoagulation, and morbidities and mortalities.Main Outcome MeasureSS patency and velocity.ResultsEight patients were included in the analysis (22 to 69 years). Four had left-sided and four had right-sided craniotomies. Sigmoid sinuses were either right-side dominant or co-dominant. The mean velocity ± standard deviation (SD) prior to dura opening and abdominal fat packing was 23.2 ± 11.3 and 25.5 ± 13.9 cm/s, respectively, p = 0.575. Post-operative Magnetic Resonance Venography (MRV) imaging showed four sigmoid sinus occlusions; seven patients showed sigmoid sinus stenosis, and one internal jugular vein occlusion. One patient had post-operative Computed Tomography Venography (CTV) only. Of the four patients with MRV occlusions, CTVs were performed with three showing occlusion and all four-showing stenosis. One patient with internal jugular vein occlusion on MRV received warfarin anticoagulation. There was one cerebrospinal fluid leak requiring ear closure, one small cerebellar infarct, and one with facial nerve palsy (House-Brackman Grade 3).ConclusionSS velocity changes before and after tumor resection were not predictive of sinus occlusion. We hypothesize that sinus occlusion may be caused by related factors other than thrombosis, such as external compression of the sinus secondary to abdominal fat grafting.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Role of Intra-Operative Duplex Ultrasonography Following Translabyrinthine Approach for Vestibular Schwannoma

et al. 2022

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“…It provides wide exposure of the cerebellopontine angle and gives an opportunity to resect large tumors and preserve hearing in some cases. Lateral sinus thrombosis is a known complication after the posterior fossa surgery and has been noted in 4.7-11.6% of cases [2][3][4][5][6][7][8]. However, there is limited data about that complication exclusively in the vestibular schwannoma surgery.…”

Section: Discussionmentioning

confidence: 99%

Dural sinus thrombosis after resection of vestibular schwannoma using suboccipital retrosigmoid approach—thrombosis classification and management proposal

et al. 2022

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ObjectiveDural sinus thrombosis is one of the complications after posterior fossa surgery. However, that topic is not described well with regard to vestibular schwannoma surgery using the unique suboccipital retrosigmoid approach. MethodsWe analyzed retrospectively medical records and radiological investigations of 116 patients. The including criteria were: histopathologically con rmed vestibular schwannoma operated on using the retrosigmoid approach, preoperative and postoperative contrast enhanced MRI, at least 1-year follow-up. ResultsThe patient group included 36% males, 64% females. The average age was 47.3±13.9 years. 60% of tumors were classi ed as T4b according to the Hannover scale and their mean volume was 13.73±10.28 cm 3 . There were no signs of thrombosis preoperatively. In 26 (22%) cases, postoperative changes in the dural sinuses were found. In 7 (27%) cases there was an external compression by the hemostatic agent, in 19 (73%) cases a thrombus was visualized in the sinus lumen. The size of the sinus, age, tumor size were not risk factors for thrombosis, whereas an intraoperative sinus injury was a statistically signi cant risk factor (p=0.0012). All of the patients diagnosed with thrombosis were in good clinical condition in distant follow-up (mRankin=0). Complete recanalization was observed in 58% of cases after 1-year follow-up. ConclusionsPostoperative changes in the dural venous sinuses are a frequent nding after vestibular schwannoma surgery using the suboccipital retrosigmoid approach. Intraoperative dural injury is a risk factor for thrombosis. Thrombosis in that group of patients is usually asymptomatic and does not in uence the prognosis.

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“…7,[16][17][18] Several studies on cerebellopontine region tumors have also reported a correlation of CSF leakage with pCVST. [19][20][21] Reported rates of pCVSTrange from 6.0 to 38.9% in the literature specific to VS and 11.6 to 15.9% for general cerebellopontine angle masses. 18,[20][21][22] Because of the asymptomatic nature of most pCVST, recent studies suggest a historical underestimation of this radiographic finding with increased utilization and advancements in neuroimaging, contributing to the recent surge in literature on pCVST.…”

Section: Discussionmentioning

confidence: 99%

“…[19][20][21] Reported rates of pCVSTrange from 6.0 to 38.9% in the literature specific to VS and 11.6 to 15.9% for general cerebellopontine angle masses. 18,[20][21][22] Because of the asymptomatic nature of most pCVST, recent studies suggest a historical underestimation of this radiographic finding with increased utilization and advancements in neuroimaging, contributing to the recent surge in literature on pCVST. 7 Several recent case series published from 2016 to 2020 reflect the drive to understand its epidemiology, clinical implications, and management.…”

Section: Discussionmentioning

confidence: 99%

Functional Outcomes and Postoperative Cerebral Venous Sinus Thrombosis after Translabyrinthine Approach for Vestibular Schwannoma Resection: A Radiographic Demonstration of Anatomic Predictors

Gerges

Malloy

Rabah

et al. 2021

J Neurol Surg B Skull Base

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Introduction While regarded as an effective surgical approach to vestibular schwannoma (VS) resection, the translabyrinthine (TL) approach is not without complications. It has been postulated that postoperative cerebral venous sinus thrombosis (pCVST) may occur as a result of injury and manipulation during surgery. Our objective was to identify radiologic, surgical, and patient-specific risk factors that may be associated with pCVST. Methods The Institutional Review Board (IRB) approval was obtained and the medical records of adult patients with VS who underwent TL craniectomy at University Hospitals Cleveland Medical Center between 2009 and 2019 were reviewed. Demographic data, radiographic measurements, and tumor characteristics were collected. Outcomes assessed included pCVST and the modified Rankin score (mRS). Results Sixty-one patients ultimately met inclusion criteria for the study. Ten patients demonstrated radiographic evidence of thrombus. Patients who developed pCVST demonstrated shorter internal auditory canal (IAC) to sinus distance (mean: 22.5 vs. 25.0 mm, p = 0.044) and significantly smaller petrous angles (mean: 26.3 vs. 32.7 degrees, p = 0.0045). Patients with good mRS scores (<3) appeared also to have higher mean petrous angles (32.5 vs. 26.8, p = 0.016). Koos' grading and tumor size, in our study, were not associated with thrombosis. Conclusion More acute petrous angle and shorter IAC to sinus distance are objective anatomic variables associated with pCVST in TL surgical approaches.

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Dural venous sinus thrombosis after cerebellopontine angle surgery: Should it be treated?

Cited by 10 publications

References 9 publications

The Role of Intra-Operative Duplex Ultrasonography Following Translabyrinthine Approach for Vestibular Schwannoma

The Role of Intra-Operative Duplex Ultrasonography Following Translabyrinthine Approach for Vestibular Schwannoma

Dural sinus thrombosis after resection of vestibular schwannoma using suboccipital retrosigmoid approach—thrombosis classification and management proposal

Functional Outcomes and Postoperative Cerebral Venous Sinus Thrombosis after Translabyrinthine Approach for Vestibular Schwannoma Resection: A Radiographic Demonstration of Anatomic Predictors

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