title: Otogenic lateral sinus thrombosis: case series and controversies.
abstract: OBJECTIVE
  The aim of this study is to (1) report the clinical presentation, treatment, and sequelae in a series of pediatric patients with otogenic lateral sinus thrombosis and (2) to review the most controversial aspects of management of this rare intracranial complication of otitis media.
  
  
  METHODS
  Retrospective chart review of inpatients treated for central venous thrombosis at a tertiary care facility between 1996 and 2012.
  
  
  RESULTS
  Five pediatric patients (four male, one female) were identified with otogenic lateral sinus thrombosis. Age at presentation ranged from 13 months to 15 years. All underwent a surgical procedure, ranging from a simple myringotomy with tympanostomy tube placement to tympanomastoidectomy and internal jugular vein ligation or craniotomy. Three were anticoagulated with unfractionated heparin with subsequent transition to low molecular weight heparin of variable duration. One patient developed a non-life-threatening intracranial hemorrhage while on long-term anticoagulation. Follow-up imaging, when available, did not directly correlate complete thrombus resolution with use of anticoagulation or with persistent symptoms.
  
  
  CONCLUSIONS
  Otogenic lateral sinus thrombosis is a rare intracranial complication of otitis media with significantly reduced morbidity and mortality in the modern era of antibiotic treatment, surgical intervention, and anticoagulation therapy. Due to the rarity of this condition today, the recommended extent of surgical intervention and need for routine anticoagulation are unclear, and requires further data to determine definitively.
authors.affiliation: Department of Otolaryngology, University of California Davis Medical Center, United States. Electronic address: jamie.funamura@gmail.com.
authors.forename: Jamie L
authors.initials: JL
authors.lastname: Funamura
authors.affiliation: University of California Davis School of Medicine, United States.
authors.forename: Alexander T
authors.initials: AT
authors.lastname: Nguyen
authors.affiliation: Department of Otolaryngology, University of California Davis Medical Center, United States.
authors.forename: Rodney C
authors.initials: RC
authors.lastname: Diaz
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003399:Craniotomy / Q000379:methods; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D020227:Lateral Sinus Thrombosis / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D008026:Ligation / Q000379:methods; D018810:Magnetic Resonance Angiography / Q000379:methods; D008297:Male; D008417:Mastoiditis / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D008876:Middle Ear Ventilation / Q000379:methods; D010033:Otitis Media / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D012189:Retrospective Studies; D012494:Sampling Studies; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants
keywords: Acute otitis media; Anticoagulation; Complications; Intracranial; Lateral sinus thrombosis; Otomastoiditis