title: Presentation and management of lateral sinus thrombosis following posterior fossa surgery.
abstract: OBJECTIVE There are no guidelines for the management of postoperative lateral sinus thrombosis following posterior fossa surgery. Introducing treatment-dose anticoagulant therapy during the immediate postoperative period increases the risk of intracranial bleeding. This study assessed the incidence of and risk factors associated with postoperative lateral sinus thrombosis and the complications related to thrombosis and/or anticoagulation. METHODS This study was a retrospective monocentric analysis of adult patients who underwent surgical removal of a posterior fossa space-occupying lesion with available postoperative imaging. Postoperative lateral sinus thrombosis was defined as a T2*hypointensity within the venous sinus and/or a filling defect on postcontrast MRI or CT scan. RESULTS Among 180 patients, 12 (6.7%; 95% CI 3.0-10.4) were found to have lateral sinus thrombosis on postoperative imaging, none of whom were symptomatic. Unadjusted risk factors for postoperative lateral sinus thrombosis were a history of deep venous thrombosis (p = 0.016), oral contraceptive pill (p = 0.004), midline surgical approach (p = 0.035), and surgical exposure of the sinus (p < 0.001). Seven of the patients (58.3%) with a postoperative lateral sinus thrombosis received immediate treatment-dose anticoagulant therapy. Lateral sinus recanalization occurred radiologically at a mean time of 272 ± 23 days in 85.7% of patients (6 of 7) undergoing treatment-dose anticoagulant therapy and in 20% of patients (1 of 5) not receiving treatment-dose anticoagulant therapy. Postoperative complications occurred in 56.2% of patients (9 of 16) who received treatment-dose curative anticoagulant therapy and in 27% of patients (45 of 164) who did not. CONCLUSIONS Incidental radiological lateral sinus thrombosis following posterior fossa surgery has an incidence of 6.7%. To further define the benefit-to-risk ratio of a treatment-dose anticoagulant therapy, a prospective trial should be considered.
authors.affiliation: Departments of 1 Neurosurgery.|Paris Descartes University, Sorbonne Paris Cité.
authors.forename: Caroline
authors.initials: C
authors.lastname: Apra
authors.affiliation: Neuroradiology.|Paris Descartes University, Sorbonne Paris Cité.
authors.forename: Owais
authors.initials: O
authors.lastname: Kotbi
authors.affiliation: Neurology.|Paris Descartes University, Sorbonne Paris Cité.|INSERM U894, Paris, France; and.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Turc
authors.affiliation: Department of Neurosurgery, Leeds General Infirmary, Leeds, United Kingdom.
authors.forename: Robert
authors.initials: R
authors.lastname: Corns
authors.affiliation: Neuropathology, and.|Paris Descartes University, Sorbonne Paris Cité.
authors.forename: Mélanie
authors.initials: M
authors.lastname: Pagès
authors.affiliation: Neuroradiology.|Paris Descartes University, Sorbonne Paris Cité.
authors.forename: Raphaëlle
authors.initials: R
authors.lastname: Souillard-Scémama
authors.affiliation: Departments of 1 Neurosurgery.|Paris Descartes University, Sorbonne Paris Cité.
authors.forename: Edouard
authors.initials: E
authors.lastname: Dezamis
authors.affiliation: Departments of 1 Neurosurgery.|Paris Descartes University, Sorbonne Paris Cité.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Parraga
authors.affiliation: Neuroradiology.|Paris Descartes University, Sorbonne Paris Cité.|INSERM U894, Paris, France; and.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Meder
authors.affiliation: Neuro-Anaesthesia and Neuro-Intensive Care, Sainte-Anne Hospital.|Paris Descartes University, Sorbonne Paris Cité.
authors.forename: Xavier
authors.initials: X
authors.lastname: Sauvageon
authors.affiliation: Departments of 1 Neurosurgery.|Paris Descartes University, Sorbonne Paris Cité.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Devaux
authors.affiliation: Neuroradiology.|Paris Descartes University, Sorbonne Paris Cité.|INSERM U894, Paris, France; and.
authors.forename: Catherine
authors.initials: C
authors.lastname: Oppenheim
authors.affiliation: Departments of 1 Neurosurgery.|Paris Descartes University, Sorbonne Paris Cité.
authors.forename: Johan
authors.initials: J
authors.lastname: Pallud
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D005260:Female; D006801:Humans; D015994:Incidence; D015192:Infratentorial Neoplasms / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D012851:Sinus Thrombosis, Intracranial / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy*; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D000925:Anticoagulants
keywords: anticoagulation; lateral sinus; posterior fossa; surgery; thrombosis; vascular disorders