J Neurol Surg B Skull Base 2021; 82(S 03): e3-e8
DOI: 10.1055/s-0039-3400296
Original Article

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
› Institutsangaben

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.



Publikationsverlauf

Eingereicht: 31. Mai 2019

Angenommen: 27. September 2019

Artikel online veröffentlicht:
21. November 2019

© 2019. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 Ferro JM, Canhão P, Stam J, Bousser M-G, Barinagarrementeria F. ; ISCVT Investigators. Prognosis of cerebral vein and dural sinus thrombosis: results of the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT). Stroke 2004; 35 (03) 664-670
  • 2 Stam J, De Bruijn SF, DeVeber G. Anticoagulation for cerebral sinus thrombosis. Cochrane Database Syst Rev 2002; (04) CD002005
  • 3 Zuluaga MI, Massaro M, Franco CA. [Cerebral venous sinus thrombosis: Epidemiology, clinical characteristics, imaging and prognosis]. Biomed Rev Inst Nac Salud 2015; 35: 196-203
  • 4 Shew M, Kavookjian H, Dahlstrom K. et al. Incidence and risk factors for sigmoid venous thrombosis following CPA tumor resection. Otol Neurotol 2018; 39 (05) e376-e380
  • 5 Zuurbier SM, van den Berg R, Troost D, Majoie CB, Stam J, Coutinho JM. Hydrocephalus in cerebral venous thrombosis. J Neurol 2015; 262 (04) 931-937
  • 6 Abou-Al-Shaar H, Gozal YM, Alzhrani G, Karsy M, Shelton C, Couldwell WT. Cerebral venous sinus thrombosis after vestibular schwannoma surgery: a call for evidence-based management guidelines. Neurosurg Focus 2018; 45 (01) E4
  • 7 Ferro JM, Canhão P. Cerebral venous sinus thrombosis: update on diagnosis and management. Curr Cardiol Rep 2014; 16 (09) 523
  • 8 Sawarkar DP, Verma SK, Singh PK, Doddamani R, Kumar A, Sharma BS. Fatal superior sagittal sinus and torcular thrombosis after vestibular schwannoma surgery: report of a rare complication and review of the literature. World Neurosurg 2016; 96: 607.e19-607.e24
  • 9 Goyal G, Charan A, Singh R. Clinical presentation, neuroimaging findings, and predictors of brain parenchymal lesions in cerebral vein and dural sinus thrombosis: a retrospective study. Ann Indian Acad Neurol 2018; 21 (03) 203-208
  • 10 Yeh C-H, Chao C-M. Cerebral venous thrombosis. J Emerg Med 2018; 55 (03) e83-e84
  • 11 Bonneville F. Imaging of cerebral venous thrombosis. Diagn Interv Imaging 2014; 95 (12) 1145-1150
  • 12 Sari S, Verim S, Hamcan S. et al. MRI diagnosis of dural sinus - Cortical venous thrombosis: Immediate post-contrast 3D GRE T1-weighted imaging versus unenhanced MR venography and conventional MR sequences. Clin Neurol Neurosurg 2015; 134: 44-54
  • 13 Keiper Jr. GL, Sherman JD, Tomsick TA, Tew Jr JM. Dural sinus thrombosis and pseudotumor cerebri: unexpected complications of suboccipital craniotomy and translabyrinthine craniectomy. J Neurosurg 1999; 91 (02) 192-197
  • 14 Sade B, Mohr G, Dufour J-J. Vascular complications of vestibular schwannoma surgery: a comparison of the suboccipital retrosigmoid and translabyrinthine approaches. J Neurosurg 2006; 105 (02) 200-204
  • 15 Moore J, Thomas P, Cousins V, Rosenfeld JV. Diagnosis and management of dural sinus thrombosis following resection of cerebellopontine angle tumors. J Neurol Surg B Skull Base 2014; 75 (06) 402-408
  • 16 Benjamin CG, Sen RD, Golfinos JG. et al. Postoperative cerebral venous sinus thrombosis in the setting of surgery adjacent to the major dural venous sinuses. J Neurosurg 2018; DOI: 10.3171/2018.4.JNS18308.
  • 17 Jean WC, Felbaum DR, Stemer AB, Hoa M, Kim HJ. Venous sinus compromise after pre-sigmoid, transpetrosal approach for skull base tumors: A study on the asymptomatic incidence and report of a rare dural arteriovenous fistula as symptomatic manifestation. J Clin Neurosci 2017; 39: 114-117
  • 18 Ohata K, Haque M, Morino M. et al. Occlusion of the sigmoid sinus after surgery via the presigmoidal-transpetrosal approach. J Neurosurg 1998; 89 (04) 575-584
  • 19 Patel D, Machnowska M, Symons S. et al. Diagnostic performance of routine brain mri sequences for dural venous sinus thrombosis. AJNR Am J Neuroradiol 2016; 37 (11) 2026-2032
  • 20 Sadigh G, Mullins ME, Saindane AM. Diagnostic performance of MRI sequences for evaluation of dural venous sinus thrombosis. AJR Am J Roentgenol 2016; 206 (06) 1298-1306
  • 21 Apra C, Kotbi O, Turc G. et al. Presentation and management of lateral sinus thrombosis following posterior fossa surgery. J Neurosurg 2017; 126 (01) 8-16
  • 22 Medel R, Monteith SJ, Crowley RW, Dumont AS. A review of therapeutic strategies for the management of cerebral venous sinus thrombosis. Neurosurg Focus 2009; 27 (05) E6