title: Pediatric otogenic lateral sinus thrombosis: role of anticoagulation and surgery.
abstract: OBJECTIVE
  1. To discuss the presentation, work up, and treatment of a series pediatric patients presenting with acute otogenic lateral sinus thrombosis (OLST). 2. To review the literature in discussing surgical treatment and the role of anticoagulation for sinus thrombosis from complicated otomastoiditis.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Retrospective case series of seven patients with otomastoidits and lateral sinus thrombosis were included in the study. Type of anticoagulation used and both clinical and radiographic outcomes were compared. Pediatric literature review was conducted using PubMed search terms "thrombosis and otitis media and anticoagulation" limited to English.
  
  
  RESULTS
  Seven patients presented with acute otomastoiditis with sigmoid sinus thrombosis. Six patients were treated with anticoagulation for 1.5-12 months. Six patients underwent myringotomy with tube and 4 patients underwent cortical mastoidectomy without thrombectomy. Six patients had resolution of thrombosis by imaging in less than 6 months. Literature review of 19 pts with OLST showed that 95% had mastoidectomy and 84% had myrigotomy with tube. All 19 patients received anticoagulation. Sixteen patients had complete clinical recovery with recanalization or resolution of clot in 3 patients.
  
  
  CONCLUSIONS
  The treatment of OLST is controversial. Most (23/26) patients had complete clinical recovery despite clot resolution in 9 of the 26 patients. Four patients had bleeding complication with anticoagulation. This series and literature review highlights the controversy of surgery and use of anticoagulation in the treatment of OLST and the need for further investigation.
authors.affiliation: Medical College of Wisconsin, Milwaukee, Wisconsin, United States. msitton@mcw.edu
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Sitton
authors.forename: Robert
authors.initials: R
authors.lastname: Chun
mesh_terms: D000293:Adolescent; D000925:Anticoagulants / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D020227:Lateral Sinus Thrombosis / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008417:Mastoiditis / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D008876:Middle Ear Ventilation; D010027:Osteotomy; D010033:Otitis Media / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants