Septic Thrombophlebitis of the Sigmoid Sinus after Vestibular Schwannoma Resection: A Case Report and Literature Review
Introduction: The translabyrinthine approach has been increasingly used in the removal of tumors of the cerebellopontine angle. Thrombosis of the sigmoid sinus (TSS) is a possible complication of this surgical approach.
Case report: A 69-year-old man, with left-sided progressive hearing loss and tinnitus for three years was used as the subject. Audiometry showed deafness in left ear. MRI showed a lesion of 1.5 cm in the left cerebellopontine angle. He underwent to surgical resection via the translabyrinthine approach. On the 15th postoperative day, he developed headache, blurred vision, dizziness, nausea, and fever without signs of meningeal irritation or other neurological deficits. The wound showed signs of inflammation and serous secretion. Imaging tests showed elongated filling defect extending from the transverse sinus to the sigmoid sinus to the left. He underwent intravenous antibiotic, and showed good clinical outcome.
Discussion: The TSS is a rare complication of resection of VS. Among the possible explanations for its occurrence include retraction within the intraoperative sinus dissection during resection of the tumor and the spread of infectious processes from the mastoid causing septic thrombophlebitis. Contrast-enhanced CT can find central triangular area not highlighted and is bounded by the collecting dura contrast, also known as a sign of “empty delta.” Treatment may include anticoagulation, antibiotic therapy, and surgical procedures.
Considerations: The incidence of TSS decreased after intravenous antibiotic treatment. Its diagnosis requires clinical suspicion and imaging studies.