Management and outcome of spontaneous cerebral venous sinus thrombosis in a 5-year consecutive single-institution cohort.
BACKGROUND
Cerebral venous sinus thrombosis (CVST) is an uncommon form of stroke with a variable presentation, ranging from headaches, to coma and death. Although the American Stroke Association has developed guidelines for the treatment of CVST, data are sparse on the outcome after treatment with anticoagulation, thrombolysis, and thrombectomy.


METHODS
In this retrospective review, we describe the 5-year UC Davis experience with spontaneous CVST.


RESULTS
Forty-one patients (mean age 37.5±23.1, range 0-96 years; 29 female) were identified with CVST. The majority of cases involved the transverse sinus (75.6%), sigmoid sinus (58.5%), and superior sagittal sinus (29.3%). The most common form of treatment was anticoagulation or antiplatelet therapy (n=35), while six patients were managed by observation alone. The overall 1-year modified Rankin score (mRS) was 1.4±1.5. Male patients and patients with a poor admission mRS had a worse outcome. Outcome was unaffected by hypercoagulable state, number of dural sinuses involved, the presence of intracranial hemorrhage, or seizures. Two patients who underwent anticoagulation therapy also required endovascular thrombectomy; both patients had a 1-year mRS of ≤2. Two patients underwent direct open surgical canalization of the superior sagittal sinus with varying outcomes (mRS 2 vs mRS 6).


CONCLUSIONS
In our series, the majority (92.9%) of patients with spontaneous dural sinus thrombosis had a favorable clinical outcome as defined by a mRS ≤2. Further prospective studies are needed to study the impact of anticoagulation on the clinical course of the disease.
Department of Neurological Surgery, University of California-Davis Medical Center, Sacramento, California, USA.
Darrin J
DJ
Lee
Department of Neurological Surgery, University of California-Davis Medical Center, Sacramento, California, USA.
Arjang
A
Ahmadpour
Department of Neurological Surgery, University of California-Davis Medical Center, Sacramento, California, USA.
Tamar
T
Binyamin
Department of Radiology, University of California-Davis Medical Center, Sacramento, California, USA.
Brian C
BC
Dahlin
Department of Neurological Surgery, University of California-Davis Medical Center, Sacramento, California, USA.
Kiarash
K
Shahlaie
Department of Neurological Surgery, University of California-Davis Medical Center, Sacramento, California, USA.
Ben
B
Waldau
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003131:Combined Modality Therapy / Q000379:methods; D003392:Cranial Sinuses / Q000000981:diagnostic imaging; D019468:Disease Management; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D020300:Intracranial Hemorrhages / Q000000981:diagnostic imaging / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D012851:Sinus Thrombosis, Intracranial / Q000000981:diagnostic imaging* / Q000628:therapy*; D020521:Stroke / Q000000981:diagnostic imaging / Q000628:therapy; D017131:Thrombectomy / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult
D000925:Anticoagulants; D005343:Fibrinolytic Agents
Thrombectomy; Thrombolysis