Endovascular Treatment of Children With Cerebral Venous Sinus Thrombosis: A Case Series

Mortimer, Alex; Bradley, Marcus; O’Leary, Suzanne; Renowden, Shelley

doi:10.1016/j.pediatrneurol.2013.07.008

Cited by 35 publications

(34 citation statements)

References 16 publications

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“…CSVT is a rare condition affecting 0.56–0.67/100,000 children/year, with high mortality and long-term neurological deficits [5]. However, the incidence may be underestimated depending on thrombus location and absence of symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…However, the incidence may be underestimated depending on thrombus location and absence of symptoms. Risk factors producing a prothrombotic state include dehydration, renal failure, trauma, cancer, and hematologic disorders such as iron-deficiency anemia [5]. Thrombosis is frequent in the lateral and superior sagittal sinuses, and a simple unenhanced CT scan may diagnose CSVT [6].…”

Section: Discussionmentioning

confidence: 99%

“…Thrombosis is frequent in the lateral and superior sagittal sinuses, and a simple unenhanced CT scan may diagnose CSVT [6]. Symptomatic or supportive measures associated with antithrombotic therapy and anticoagulation with heparin are standard treatment and are associated with improved outcomes [1, 5]. …”

Section: Discussionmentioning

confidence: 99%

“…According to Mortimer et al . [5], anticoagulation has the capacity to avoid thrombus propagation, allowing sinus recanalization. Chronic use of oral anticoagulants may be difficult in children and has limitations, including the need for coagulation monitoring and drug and food interactions; however, new drugs such as thrombin inhibitor have been tested in children and demonstrate safety and efficacy [10].…”

Section: Discussionmentioning

confidence: 99%

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Endovascular Treatment of a Dural Arteriovenous Fistula after Cerebral Sinovenous Thrombosis in a Child

et al. 2018

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Background: Dural arteriovenous fistula (DAVF) is rare in children. Development theories postulate a response to cerebral sinovenous thrombosis (CSVT) or to venous hypertension. The symptoms are highly nonspecific and depend on lesion location. Standard treatment of thrombosis is based on antithrombotic therapy, while the main therapy for DAVF is embolization. Case Report: An 8-year-old boy presented with headache was diagnosed with CSVT and treated with anticoagulant. He developed tinnitus, mental confusion, and lowering of consciousness. Magnetic resonance imaging showed a DAVF draining through a single stenotic venous sinus. Successful endovascular treatment was performed with arterial embolization of multiple feeders and stent and balloon sinus angioplasty. Conclusion: Risk factors associated with sinus thrombosis must be always investigated; endovascular treatment is safe and reasonable in a clinical deterioration scenario.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Endovascular Treatment of a Dural Arteriovenous Fistula after Cerebral Sinovenous Thrombosis in a Child

et al. 2018

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“…Having said that, the cases described in the published case reports are for patients who either presented with severe complications (coma) or were not responsive to anticoagulation, so more aggressive approaches are not to be completely dismissed. 7,8 Anticoagulation is the mainstay of management of CSVT and is based on extrapolation from clinical trials in adults with a Cochrane review of those trials supporting the benefit of anticoagulation. 9 Pediatric trials have not been performed.…”

Section: Challenges and Choicesmentioning

confidence: 99%

How I treat pediatric venous thromboembolism

Young

2017

Blood

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The incidence of pediatric venous thromboembolism (VTE) has been increasing significantly over the past decade in part as a result of increased recognition of this serious disorder but more so because of the increased use of central venous catheters and other technological advancements involved in the care of ill children. Management of pediatric VTE is a complex undertaking, considering that the vast majority of children who develop this complication have serious underlying medical disorders. Although the incidence is rising, in comparison with adults, this remains a relatively rare disorder, and as such, large-scale clinical trials have not been completed, rendering management decisions to be based on extrapolation from adult data and the experience of the treating physician. Clearly, both are fraught with problems. Thus, day-to-day management remains more art than science until such time that the results from clinical trials (many of which are under way) become available. This edition of “How I Treat” describes the author’s experience in managing 3 common scenarios that one may encounter in pediatric thrombosis and suggests a logical approach to such situations. Furthermore, the author provides 3 algorithms to help guide management decisions.

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