Lateral sinus thrombosis: a review of seven cases and proposal of a management algorithm.
OBJECTIVE
To evaluate the demographics, diagnosis, management, and outcomes of lateral sinus thrombosis in a pediatric population, and to propose a new treatment algorithm.


METHODS
Retrospective review of seven patients.


RESULTS
Patients averaged 7.4 years of age. They commonly presented with headache and otalgia (seven of seven patients), and nausea and vomiting (six of seven patients). All patients had abnormal otoscopy, and four of seven patients had a lateral rectus palsy, but fever was not always present (only three of seven patients). All patients underwent MRI with venography (MRV) for diagnosis. All patients were admitted to the hospital (average length of stay 8 days) and treated with antibiotics (six of seven patients with i.v. ceftriaxone). Five of seven were treated with simple mastoidectomy and concurrent middle ear ventilation tubes; two patients received only medical treatment. The average follow up was 114 months (range 33-387 months). Two patients had long-term sequela: one had persistent mild lateral gaze diplopia and another had unilateral moderate to severe high frequency sensorineural hearing loss. Six of seven patients had follow up imaging (average 15 months, range 1-40 months). Four of six patients showed recanalization of the lateral sinus on repeat imaging. Based on the current experience in the modern era of MRV and broad-spectrum antibiotics, a new treatment algorithm is proposed.


CONCLUSIONS
Lateral sinus thrombosis is an uncommon cranial complication of otitis media. The advent of non-invasive diagnosis and effective broad-spectrum antibiotics has drastically decreased the mortality and altered the diagnostic and treatment paradigm.
Christensen
Nathan
N
Department of Otolaryngology, University of Rochester, 2365 South Clinton Avenue, Rochester, NY 14618, USA. nathan_christensen@urmc.rochester.edu
Wayman
John
J
Spencer
Jared
J
D000465:Algorithms; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D020227:Lateral Sinus Thrombosis / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D007902:Length of Stay; D008279:Magnetic Resonance Imaging; D008297:Male; D008416:Mastoid / Q000601:surgery*; D010033:Otitis Media / Q000150:complications*; D013517:Otorhinolaryngologic Surgical Procedures; D010690:Phlebography / Q000009:adverse effects; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents