J Neurol Surg B
DOI: 10.1055/s-0039-3400296
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Dural Venous Sinus Thrombosis after Vestibular Schwannoma Surgery: The Anticoagulation Dilemma

Bledi C. Brahimaj
1  Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, United States
,
Andre Beer-Furlan
1  Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, United States
,
Fred Crawford
2  Rush University College of Medicine, Chicago, Illinois, United States
,
Ravi Nunna
1  Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, United States
,
Matthew Urban
2  Rush University College of Medicine, Chicago, Illinois, United States
,
Gary Wu
2  Rush University College of Medicine, Chicago, Illinois, United States
,
Eric Abello
2  Rush University College of Medicine, Chicago, Illinois, United States
,
Vikrant Chauhan
3  Department of Otolaryngology, Rush University Medical Center, Chicago, Illinois, United States
,
Mehmet Kocak
4  Department of Diagnostic Radiology, Rush University Medical Center, Chicago, Illinois, United States
,
Lorenzo Muñoz
1  Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, United States
,
Richard M. Wiet
3  Department of Otolaryngology, Rush University Medical Center, Chicago, Illinois, United States
,
Richard W. Byrne
1  Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, United States
› Author Affiliations
Further Information

Publication History

31 May 2019

27 September 2019

Publication Date:
21 November 2019 (online)

Abstract

Introduction Dural venous sinus thrombosis (DVST) is a relatively understudied complication of vestibular schwannoma (VS) surgery. Several studies have examined this topic; however, there is limited data on the incidence, clinical progression, and proper management of this patient population.

Methods A retrospective review was performed for patients undergoing surgery for VS at a single institution. All postoperative imaging was reviewed for incidence of DVST. Demographic data were collected including tumor and surgical characteristics along with postoperative course.

Results A total of 63 patients underwent resection of their VS. The incidence of DVST was 34.9%. The operative time was greater in the dural venous sinus thrombosis (DSVT) group, at an average of 6.69 hours versus 4.87 in the no DSVT cohort (p = 0.04). Tumor size was correlationally significant (p = 0.051) at 2.75 versus 2.12 cm greatest diameter. The translabyrinthine approach was most prevalent (68.2%). The side of the thrombosis was ipsilateral to the tumor and surgery in all patients. The sigmoid sinus was most commonly involved (95.5%). Of them, 85% patients had a codominant or thrombus contralateral to the dominant sinus. All patients were asymptomatic. No patients were treated with anticoagulation. Resolution of thrombus was seen in five (22.7%) of the patients on last follow-up imaging. There were no hemorrhagic complications.

Conclusion The overall incidence of DVST was (34.9%) of 63 patients who underwent VS surgery. All patients were asymptomatic and none were treated with anticoagulation. In our study, continuing to observe asymptomatic patients did not lead to any adverse events.