title: Pediatric cerebral sinovenous thrombosis following cranial surgery.
abstract: OBJECTIVE
  Pediatric cerebral sinovenous thrombosis (CSVT) is an important, though less common subtype of pediatric stroke. It has been linked to several risk factors, including cranial procedures, with few studies highlighting this relationship. The aim of this study was to characterize the diagnosis and treatment of CSVT after cranial surgery.
  
  
  METHODS
  An institutional pediatric stroke research database was used to identify all CSVT cases diagnosed within 30 days of cranial surgery from November 2004 to December 2014. Thirteen subjects were retrospectively analyzed for clinical presentation, surgical details, radiographic characteristics, laboratory study results, treatment, and outcome. Diagnostic testing and treatment adhered to a consensus-based institutional stroke protocol.
  
  
  RESULTS
  Cranial vault reconstruction, subdural empyema evacuation, and tumor resection were each observed in three subjects. Eleven (85%) subjects had sinus exposure during surgery, and eight (73%) developed thrombus in a sinus within or adjacent to the operative field. Two (15%) had documented iatrogenic sinus injury. On post-operative testing, ten (77%) subjects had prothrombotic abnormalities. Seven (54%) were treated with anti-coagulation therapy (ACT) starting on a median of post-operative day (POD) 3 (IQR 1-3) for a median of 2.9 months (IQR 2.4-5.4). Median time to imaging evidence of partial or complete recanalization was 2.4 months (IQR 0.7-5.1). No symptomatic hemorrhagic complications were encountered.
  
  
  CONCLUSIONS
  Pediatric CSVT may be encountered after cranial surgery, and decisions related to anti-coagulation are challenging. The risk of CSVT should be considered in pre-surgical planning and post-operative evaluation of cases with known risk factors. In our study, judicious use of ACT was safe in the post-operative period.
authors.affiliation: Department of Neurosurgery, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Dmitriy
authors.initials: D
authors.lastname: Petrov
authors.affiliation: Temple University School of Medicine, Philadelphia, PA, USA.
authors.forename: Michael Y
authors.initials: MY
authors.lastname: Uohara
authors.affiliation: Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Ichord
authors.affiliation: Department of Neurosurgery, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Zarina
authors.initials: Z
authors.lastname: Ali
authors.affiliation: Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Jastrzab
authors.affiliation: Department of Neurosurgery, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA.|Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: Shih-Shan
authors.initials: SS
authors.lastname: Lang
authors.affiliation: Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA. billinghurstl@email.chop.edu.
authors.forename: Lori
authors.initials: L
authors.lastname: Billinghurst
mesh_terms: D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003399:Craniotomy / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D059906:Neuroimaging / Q000379:methods; D010372:Pediatrics; D012851:Sinus Thrombosis, Intracranial / Q000000981:diagnostic imaging / Q000601:surgery*
keywords: CSVT; Cranial surgery; Pediatric stroke