Septic thrombophlebitis of the sigmoid sinus after vestibular schwannoma resection: A case report and literature review

Abstract

Introduction:The translabyrinthine approach has been increasingly used in the removal of tumors of the cerebellopontine angle. Sigmoid sinus thrombophlebitis (SST) is a possible complication of this surgical approach.Case report: Male, 69 years-old with progressive unilateral hearing loss on his left side, which started three years before, and tinnitus. Audiometry showed deafness in the left ear. MRI showed a 1.5 cm lesion in the left cerebellopontine angle. Surgical resection via translabyrinthine. Biopsy revealed vestibular schwannoma (VS). On the 15th postoperative day, he developed headache, blurred vision, dizziness, nausea and fever, no signs of meningeal irritation or other neurological deficits. The wound showed signs of inflammation. Imaging studies showed elongated filling defect extending from the transverse sinus to the sigmoid sinus on the left. He underwent intravenous antibiotic treatment, with good clinical evolution. Discussion:The SST is a rare complication in the resection of VS. Among the possible explanations of the event stand out within retraction intraoperatively; sinus dissection during resection of the tumor and the spread of infectious processes from the mastoid causing septic thrombophlebitis. On contrast-enhanced CT can find central triangular area does not enhance and is bounded by the dura mater captive contrast, also known as a sign of "empty delta". Treatment may include anticoagulation, antibiotic therapy and surgical procedures. Considerations:The incidence of SST decreased after intravenous antibiotic treatment. Diagnosis requires clinical suspicion and imaging studies.