title: Risk factors governing the development of cerebral vein and dural sinus thrombosis after craniotomy in patients with intracranial tumors.
abstract: OBJECTIVE Neurosurgical intervention may increase the risk of developing cerebral vein and dural sinus thrombosis (CVT). The clinical management of CVT in postoperative patients remains unclear. This retrospective study explores the disease occurrence, associated risk factors, and outcomes in patients with tumors who developed CVT after craniotomy. METHODS A retrospective analysis and review of patient records in those who had undergone cranial tumor removal within the authors' neurosurgical department was performed. In so doing, the authors identified a cohort of patients who developed CVT postoperatively. The study included patients who presented to the department between January 2004 and December 2013. RESULTS Of 2286 patients with intracranial lesions who underwent craniotomy, 35 (1.5%) went on to develop CVT. The authors identified the semisitting position (OR 7.55, 95% CI 3.73-15.31, p < 0.001); intraoperative sinus injury (OR 1.5, 95% CI 3.57-15.76, p < 0.001); and known CVT risk factors (OR 7.77, 95% CI 2.28-21.39, p < 0.001) as predictors of CVT development. Of note, 19 patients (54.3%) had good outcomes (modified Rankin Scale Score 0-1), whereas 9 patients (25.7%) had suffered dependency or death (modified Rankin Scale Score 4-6) at last follow-up. Intracerebral hemorrhage (OR 21.27, 95% CI 1.59-285.01, p = 0.02) and delayed delivery of an intermediate dose of low-molecular-weight heparin anticoagulation (OR 24.12, 95% CI 2.08-280.13, p = 0.01) were associated with unfavorable outcomes. CONCLUSIONS Only a minority of patients undergoing craniotomy for tumor removal develop CVT, and the majority of those who do develop CVT recover well. Early administration of an intermediate dose of low-molecular-weight heparin anticoagulation might be considered once CVT is diagnosed.
authors.affiliation: 1Department of Neurosurgery and.
authors.forename: Florian
authors.initials: F
authors.lastname: Gessler
authors.affiliation: 1Department of Neurosurgery and.
authors.forename: Markus
authors.initials: M
authors.lastname: Bruder
authors.affiliation: 1Department of Neurosurgery and.
authors.forename: Stephan
authors.initials: S
authors.lastname: Duetzmann
authors.affiliation: 2Institute of Neuroradiology, University Hospital Frankfurt, Goethe-University, Frankfurt,Germany; and.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Tritt
authors.affiliation: 3Stroke Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland.
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Bernstock
authors.affiliation: 1Department of Neurosurgery and.
authors.forename: Volker
authors.initials: V
authors.lastname: Seifert
authors.affiliation: 1Department of Neurosurgery and.
authors.forename: Christian
authors.initials: C
authors.lastname: Senft
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000150:complications* / Q000601:surgery*; D002543:Cerebral Hemorrhage / Q000453:epidemiology / Q000209:etiology; D002550:Cerebral Veins; D015331:Cohort Studies; D003399:Craniotomy / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D012851:Sinus Thrombosis, Intracranial / Q000453:epidemiology*; D015912:Thrombolytic Therapy; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000453:epidemiology*
keywords: CVT = cerebral vein and dural sinus thrombosis; ICH = intracerebral hemorrhage; IQR = interquartile range; ISCVT = International Study on Cerebral Vein and Dural Sinus Thrombosis; LMWH = low-molecular-weight heparin; anticoagulation; craniotomy; intracranial; mRS = modified Rankin Scale; neurosurgery; oncology; risk factors; sinus thrombosis