Management of lateral sinus thrombosis: update and literature review

Abstract

The management of four cases of lateral sinus thrombosis (LST) over a four-year period at the Royal Darwin Hospital is presented in this retrospective review. The patients were aboriginal and presented with otalgia, otorrhoea and sepsis. Two cases had an associated complication of an otitic hydrocephalus and a subperiosteal abscess. Cholesteatoma was found in three cases. Computed tomography (CT) scan confirmed the LST in three cases. Three patients were anaemic and thrombocytopenic. All patients had positive blood cultures. The organisms were predominantly mixed anaerobes and Bacteroides species. Three patients were managed surgically as a two-stage procedure. One patient was managed as a single-stage procedure with a modified radical mastoidectomy. Therapeutic anticoagulation was utilized in one case. There were no deaths. The prognosis of LST is good if treatment is instituted early with broad-spectrum intravenous antibiotics and surgery. The role of clot removal at surgery and the use of anticoagulation are discussed in this paper.

Unilateral Attico Antral Ear Disease with Bilateral Intracranial Complications

“…The most frequent presenting symptoms were headache, otalgia, fever, otorrhoea and vomiting and pain in the neck [8][9][10][11]. In the present case patient had otorrhoea, headache, fever and vomiting.…”

“…However, some reports have shown that the prognosis was not improved by exploring the sinus or by removing the thrombus. Removal of surrounding granulation tissue and inflammation around the sinus is sufficient for effective treatment [1,4,8,18].…”

Otological Manifestations of Nonseptic Lateral Sinus Thrombosis: A Review

“…The non septic variant of lateral sinus thrombosis is being diagnosed with increasing frequency because of the availability of CT and MRI scan. It is seen more often in women than men and it usually occurs in adolescents or adults [1][2][3].…”

“…Enhancement of the dura surrounding the sinus may be prominent, causing the ''empty triangle'', or ''delta sign'', which may suggest the diagnosis. This sign is not seen in all cases of lateral sinus thrombosis [2,12,13].…”

Complications of chronic otitis media: a retrospective analysis of 1293 cases

“…[7,8] The treatment of LST is either needle aspiration of the infected thrombus or the excision of the thrombus by incising the lateral sinus. [13][14][15] Seven et al claimed that there was no difference between these two approaches. [2] The latest studies have revealed that removal of the infected granulation tissue, without thrombus, is sufficient for recanalization of the sinus.…”