Fatal Superior Sagittal Sinus and Torcular Thrombosis After Vestibular Schwannoma Surgery: Report of a Rare Complication and Review of the Literature

Sawarkar, Dattaraj; Verma, Satish; Singh, Pankaj Kumar; Doddamani, Ramesh; Kumar, Amandeep; Sharma, Bhawani S.

doi:10.1016/j.wneu.2016.09.075

Cited by 16 publications

(17 citation statements)

References 4 publications

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“…Despite these reports, concerns for an increased risk of catastrophic hemorrhage in the acute postoperative period are rampant. 13,14 In fact, in our own study, a CVST patient treated with enoxaparin experienced severe hemorrhagic complications attributable to therapeutic anticoagulation in the immediate postoperative period.…”

Section: Management Of Cvst Associated With Surgerymentioning

confidence: 77%

Cerebral venous sinus thrombosis after vestibular schwannoma surgery: a call for evidence-based management guidelines

Abou‐Al‐Shaar

Gozal

Alzhrani

et al. 2018

Neurosurgical Focus

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OBJECTIVEPostoperative cerebral venous sinus thrombosis (CVST) is an uncommon complication of posterior fossa surgery. The true incidence of and optimal management strategy for this entity are largely unknown. Herein, the authors report their institutional incidence and management experience of postoperative CVST after vestibular schwannoma surgery.METHODSThe authors undertook a retrospective review of all vestibular schwannoma cases that had been treated with microsurgical resection at a single institution from December 2011 to September 2017. Patient and tumor characteristics, risk factors, length of stay, surgical approaches, sinus characteristics, CVST management, complications, and follow-up were analyzed.RESULTSA total of 116 patients underwent resection of vestibular schwannoma. The incidence of postoperative CVST was 6.0% (7 patients). All 7 patients developed lateral CVST ipsilateral to the lesion. Four cases occurred after translabyrinthine approaches, 3 occurred after retrosigmoid approaches, and none occurred following middle cranial fossa approaches. Patients were managed with anticoagulation or antiplatelet therapy. Although patients were generally asymptomatic, one patient experienced intraparenchymal hemorrhage, epidural hemorrhage, and obstructive hydrocephalus, likely as a result of the anticoagulation therapy. However, all 7 patients had a modified Rankin scale score of 1 at the last follow-up.CONCLUSIONSPostoperative CVST is an infrequent complication, with an incidence of 6.0% among 116 patients who had undergone vestibular schwannoma surgery at one institution. Moreover, the management of postoperative CVST with anticoagulation therapy poses a serious dilemma to neurosurgeons. Given the paucity of reports in the literature and the low incidence of CVST, additional studies are needed to better understand the cause of thrombus formation and help to establish evidence-based guidelines for CVST management and prevention.

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Section: Management Of Cvst Associated With Surgerymentioning

confidence: 77%

Cerebral venous sinus thrombosis after vestibular schwannoma surgery: a call for evidence-based management guidelines

Abou‐Al‐Shaar

Gozal

Alzhrani

et al. 2018

Neurosurgical Focus

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“…described a patient who presented with isolated SSS thrombosis and hemorrhagic venous infarction after a retrosigmoid resection of a large acoustic schwannoma. [ 16 ] They elected to withhold anticoagulation therapy due to the hemorrhage. The patient underwent a decompressive hemicraniectomy but continued to deteriorate and ultimately died.…”

Section: Discussionmentioning

confidence: 99%

“…[ 15 ] This is particularly true when the superior sagittal sinus (SSS) is involved. [ 9 - 11 , 16 ] While pCVST typically involves the lateral sinuses, reports of SSS involvement are exceedingly rare. [ 11 , 16 ] As such, management of these complications can be particularly challenging.…”

Section: Introductionmentioning

confidence: 99%

“…[ 9 - 11 , 16 ] While pCVST typically involves the lateral sinuses, reports of SSS involvement are exceedingly rare. [ 11 , 16 ] As such, management of these complications can be particularly challenging. Here, we report the only case, to the best of our knowledge, of a SSS pCVST successfully treated with anticoagulation therapy detailing the presentation, imaging findings, and management to shed further light on its treatment.…”

Section: Introductionmentioning

confidence: 99%

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Successful treatment of superior sagittal sinus thrombosis after translabyrinthine resection of metastatic neuroendocrine tumor: A case report and review of literature

Wong

2020

Surgical Neurology International

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Background: Postoperative cerebral venous sinus thrombosis (pCVST) after resection of cerebellopontine angle and posterior fossa tumor resections occur almost exclusively in the lateral venous sinuses and are generally asymptomatic. Thrombus extension and involvement of the superior sagittal sinus (SSS) – a serious and potentially devastating complication – are rarely described and, as such, successful treatment for which is still poorly understood. We report a case of pCVST involving the SSS after translabyrinthine approach for resection of a metastatic neuroendocrine tumor (NET), and the first that was successfully treated with anticoagulation therapy. Case Description: A 40-year-old man presented with headaches, diminished right-sided hearing, and ataxia was found to have a large right-sided cerebellopontine angle (CPA) lesion with extra-axial and possible intraparenchymal invasion. A retrosigmoid craniotomy for debulking and diagnosis was undertaken. Postoperative imaging revealed patent venous sinuses. Pathology confirmed NET. Further imaging revealed a likely pancreatic primary lesion. The patient then underwent subsequent translabyrinthine approach for definitive surgical resection. Postoperative imaging again revealed patent venous sinuses. The patient subsequently developed headaches on postoperative day 10 and was found to have pCVST involving the ipsilateral internal jugular to the SSS. The patient was started on therapeutic heparin with significant improvement in pCVST and symptoms. Conclusion: Extensive pCVST involving the SSS after CPA and posterior fossa tumor resections is extremely rare. Initial management with anticoagulation can yield promising results and should be initiated early in the clinical course unless otherwise contraindicated.

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“…26,35 In parallel, dehydration is believed to contribute to both the initiation and propagation of CVT, and maintenance of normovolemia or moderate hypervolemia is recommended. 14,37,48 This is particularly relevant in patients receiving hyperosmolar therapy, who are often in critical condition, and at highest risk for dehydration that may trigger a precipitous decline.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous occult intracranial hypotension precipitating life-threatening cerebral venous thrombosis: case report

Perry¹,

Graffeo²,

Brinjikji³

et al. 2018

Journal of Neurosurgery: Spine

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Spontaneous intracranial hypotension (SIH) is an uncommon headache etiology, typically attributable to an unprovoked occult spinal CSF leak. Although frequently benign, serious complications may occur, including cerebral venous thrombosis (CVT). The objective of this study was to examine a highly complicated case of CVT attributable to SIH as a lens for understanding the heterogeneous literature on this rare complication, and to provide useful, evidence-based, preliminary clinical recommendations. A 43-year-old man presented with 1 week of headache, dizziness, and nausea, which precipitously evolved to hemiplegia. CT venography confirmed CVT, and therapeutic heparin was initiated. He suffered a generalized seizure due to left parietal hemorrhage, which subsequently expanded. He developed signs of mass effect and herniation, heparin was discontinued, and he was taken to the operating room for clot evacuation and external ventricular drain placement. Intraoperatively, the dura was deflated, suggesting underlying SIH. Ventral T-1 CSF leak was identified, which failed multiple epidural blood patches and required primary repair. The patient ultimately made a complete recovery. Systematic review identified 29 publications describing 36 cases of SIH-associated CVT. Among 31 patients for whom long-term neurological outcome was reported, 25 (81%) recovered completely. Underlying coagulopathy/risk factors were identified in 11 patients (31%). CVT is a rare and potentially lethal sequela occurring in 2% of SIH cases. Awareness of the condition is poor, risking morbid complications. Evaluation and treatment should be directed toward identification and treatment of occult CSF leaks. Encouragingly, good neurological outcomes can be achieved through vigilant multidisciplinary neurosurgical and neurocritical care.

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Fatal Superior Sagittal Sinus and Torcular Thrombosis After Vestibular Schwannoma Surgery: Report of a Rare Complication and Review of the Literature

Cited by 16 publications

References 4 publications

Cerebral venous sinus thrombosis after vestibular schwannoma surgery: a call for evidence-based management guidelines

Cerebral venous sinus thrombosis after vestibular schwannoma surgery: a call for evidence-based management guidelines

Successful treatment of superior sagittal sinus thrombosis after translabyrinthine resection of metastatic neuroendocrine tumor: A case report and review of literature

Spontaneous occult intracranial hypotension precipitating life-threatening cerebral venous thrombosis: case report

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