Management of paediatric otogenic cerebral venous sinus thrombosis: a systematic review

Abstract

Conservative otological surgery with the combination of anticoagulation was the most common treatment modality found in the group of patients with good clinical outcome. However, given the current low level of evidence, a multicentre collaborative study is needed to help establish the optimum surgical approach and the role of anticoagulation in managing paediatric otogenic CVST.

Fusobacterium necrophorum, a major provider of sinus thrombosis in acute mastoiditis: A retrospective multicentre paediatric study

“…Only one literature review has been published on the management of paediatric OLST but without specifically focusing on Fusobacterium infections. Based on our experience and in accordance with the European Pediatric Neurology Society which published in 2012 specific guidelines on the management of paediatric cerebral venous thrombosis, a management scheme for Fusobacterium acute mastoiditis with thrombosis is proposed herein (Figure ).…”

Cerebral sinovenous thrombosis as a complication of otitis media

“…Thrombosis of the cerebral sinuses impedes blood flow and causes increased venous pressure which in turn results in increased ICP. In some cases,retrograde venous pressure decreases cerebral blood flow causing cerebral ischemia and infarction . Clinical features can be subtle and nonspecific, such as ear pain, fever, headache, irritability, and vomiting.…”

“…Prothrombotic condition was reported in 20% of patients with CSVT in a study by Ichord et al, and in the same study, MTHFR mutation was found in 7% of patients. Wong et al studied 190 patients with otogenic CSVT,only 50 patients were tested for thrombophilia and 28 of patients tested (56%) were found to have an abnormality. MTHFR mutation was found in five of these patients (10%).…”

“…The American Stroke Association recommends LMWH in children with CSVT outside the neonatal period, even in the presence of intracranial hemorrhage . Surgical intervention is usually conservative and includes mastoidectomy and/or myringotomy . Otogenic CSVT carries a high mortality rate of 5%‐10% and can lead to significant morbidity and long‐term neurological deficits.…”

“…In some cases,retrograde venous pressure decreases cerebral blood flow causing cerebral ischemia and infarction. 5,8,9 Clinical features can be subtle and nonspecific, such as ear pain, fever, headache, irritability, and vomiting. As the condition progresses, signs of increased ICP become more evident such as diplopia (cranial nerve VI palsy), papilledema, altered mental status, seizure, and coma.…”