Unilateral Postoperative Deep Cerebral Venous Thrombosis with Complete Recovery: A Report of 2 Cases

Abstract

Postsurgical deep brain venous thrombosis has not been well described in children before. When approaching thalamic or intraventricular lesions, extra care should be taken to prevent injury to the internal cerebral veins (ICVs) and the vein of Galen. However, even when they are well preserved during surgery, postoperative hemodynamic changes, mainly in the first 24 h, or surgical manipulation can cause thrombosis of these veins. We report 2 children with unilateral postoperative ICV thrombosis; in 1 of the patients the vein of Galen was also thrombosed. Although both patients had altered sensorium initially, no anticoagulation therapy was given, and they both recovered well. When approaching thalamic or intraventricular lesions, extra care should be taken to prevent injury to the ICV and the vein of Galen. The surgeon should respect the deep brain venous system when approaching midline structures. Both the neurosurgeon and the neuroradiologist should be aware of this possible complication in order to make a prompt diagnosis and to offer proper treatment if needed.

Unilateral Internal Cerebral Vein Thrombosis: Case Reports and Review of the Literature

“…The one case that presented on the right was in the postoperative setting after resection of a right-sided tumor. [3]. In the two cases that we presented, both were also on the left.…”

“…Our cases demonstrated thrombosis in the setting in malignancy and anemia. In addition to these, others have described deep cerebral vein thrombosis in the setting of diabetes mellitus, oral contraceptive use, hypercoagulable state, and a post-operative state [3][4][5][6][7][9][10][11][12] (Tables 1 and 2). Still, others have had no known past medical history [13][14][15].…”

“…UICVT cases published in the literature have generally followed these recommendations. The few exceptions were those that were related to post-operative thrombosis in children, in which recovery was made without any pharmacological intervention [3]. The choice of anticoagulation varied between papers, but included the recommended therapies of either heparin or low molecular weight heparin, such as enoxaparin.…”

A rare case of deep cerebral venous thrombosis secondary to traumatic epidural hematoma

“…[ 7 ] However, deep cerebral veins are far less to be involved, but the DCVT always results in poorer prognosis than other cerebral sinus thrombosis. [ 3 ] The common deep veins to be involved in the thrombosis are the internal cerebral vein, the vein of Galen or straight sinus. [ 8 ]…”

“…[ 2 ] Deep cerebral veins are far less to be involved, but the DCVT always results in poorer prognosis than other cerebral sinus thrombosis. [ 3 ] However, DCVT is extremely difficult to be diagnosed due to its nonspecific clinical symptoms and un-conspicuous imaging signs. [ 4 ]…”