Fatal Superior Sagittal Sinus and Torcular Thrombosis After Vestibular Schwannoma Surgery: Report of a Rare Complication and Review of the Literature.
BACKGROUND
Cerebral venous sinus thrombosis (CVST) is a rare condition with the potential to cause severe morbidity and mortality. CVST can also occur after vestibular schwannoma (VS) surgery with the thrombosis of transverse and sigmoid sinus. However, there is not a single report of superior sagittal sinus (SSS) thrombosis after VS surgery reported in the literature.


METHODS
A 45-year-old woman presented to our center with large left-sided solid cystic VS. On admission she was dehydrated, and after clinical stabilization, she underwent gross total excision of tumor through left retromastoid suboccipital craniotomy after cerebrospinal fluid drainage through an external ventricular drain. Surgery was uneventful, but postoperatively she had an episode of seizure. Immediate postoperative computed tomography (CT) brain scan was normal with good operative cavity. However, 24 hours later, she developed left-sided motor deficit, and a repeat CT scan showed right frontal parenchymal hemorrhage with intraventricular extension. On further evaluation, magnetic resonance venography showed entire SSS thrombosis, with patent bilateral transverse and sigmoid sinuses. She was not started on the anticoagulants in view of intracranial hemorrhage. Subsequently, she underwent right-sided decompressive craniectomy because there was progressive deterioration in her Glasgow Coma Scale, and she succumbed despite all efforts. Retrospectively, dehydration and intracranial hypotension could be likened to her sinus thrombosis.


CONCLUSIONS
This case underscores the significance of adequate optimization of the patients prior to surgery, besides adequate operative skills to avoid this rare but serious complication of SSS and torcular thrombosis after VS surgery.
Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, Delhi, India.
Dattaraj Paramanand
DP
Sawarkar
Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, Delhi, India.
Satish Kumar
SK
Verma
Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, Delhi, India. Electronic address: drpankajsingh11@gmail.com.
Pankaj Kumar
PK
Singh
Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, Delhi, India.
Ramesh
R
Doddamani
Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, Delhi, India.
Amandeep
A
Kumar
Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, Delhi, India.
Bhawani Shanker
BS
Sharma
D003399:Craniotomy; D019299:Decompression, Surgical; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D020300:Intracranial Hemorrhages / Q000401:mortality / Q000601:surgery; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality*; D035583:Rare Diseases; D012086:Reoperation; D012851:Sinus Thrombosis, Intracranial / Q000401:mortality*; D054063:Superior Sagittal Sinus; D014057:Tomography, X-Ray Computed
Cerebral venous sinus thrombosis; Retromastoid approach; Superior sagittal sinus; Vestibular schwannoma