Transverse Sinus Thrombosis after Posterior Fossa Surgery for Cerebellar Tumor Treated by Endovascular Thrombectomy

Dural sinus thrombosis is a rare complication after posterior fossa surgery, particularly in cerebellar tumour surgery. The authors describe the case of a young male patient who presented a postoperative neurological deterioration due to transverse sinus thrombosis after surgery for cerebellar medulloblastoma. He was treated by mechanical clot thrombectomy using an endovascular catch system technique without anticoagulation therapy. Final angiographic recanalization was obtained. This kind of endoluminal mechanical revascularization is an efficacious method to treat dural sinus thrombosis during perioperative time but speed in diagnosis is crucial for clinical outcome.

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Dural sinus thrombosis and pseudotumor cerebri: unexpected complications of suboccipital craniotomy and translabyrinthine craniectomy

Journal of Neurosurgery ◽

10.3171/jns.1999.91.2.0192 ◽

1999 ◽

Vol 91 (2) ◽

pp. 192-197 ◽

Cited By ~ 52

Author(s):

Glenn L. Keiper ◽

Jonathan D. Sherman ◽

Thomas A. Tomsick ◽

John M. Tew

Keyword(s):

Sinus Thrombosis ◽

Pseudotumor Cerebri ◽

Transverse Sinus ◽

Dural Sinus ◽

Posterior Fossa Surgery ◽

Dural Sinus Thrombosis ◽

Mr Venography ◽

Content Type ◽

Suboccipital Craniotomy ◽

Fine Print

Object. The goal of this study was to document the hazards associated with pseudotumor cerebri resulting from transverse sinus thrombosis after tumor resection. Dural sinus thrombosis is a rare and potentially serious complication of suboccipital craniotomy and translabyrinthine craniectomy. Pseudotumor cerebri may occur when venous hypertension develops secondary to outflow obstruction. Previous research indicates that occlusion of a single transverse sinus is well tolerated when the contralateral sinus remains patent.Methods. The authors report the results in five of a total of 107 patients who underwent suboccipital craniotomy or translabyrinthine craniectomy for resection of a tumor. Postoperatively, these patients developed headache, visual obscuration, and florid papilledema as a result of increased intracranial pressure (ICP). In each patient, the transverse sinus on the treated side was thrombosed; patency of the contralateral sinus was confirmed on magnetic resonance (MR) imaging. Four patients required lumboperitoneal or ventriculoperitoneal shunts and one required medical treatment for increased ICP. All five patients regained their baseline neurological function after treatment. Techniques used to avoid thrombosis during surgery are discussed.Conclusions. First, the status of the transverse and sigmoid sinuses should be documented using MR venography before patients undergo posterior fossa surgery. Second, thrombosis of a transverse or sigmoid sinus may not be tolerated even if the sinus is nondominant; vision-threatening pseudotumor cerebri may result. Third, MR venography is a reliable, noninvasive means of evaluating the venous sinuses. Fourth, if the diagnosis is made shortly after thrombosis, then direct endovascular thrombolysis with urokinase may be a therapeutic option. If the presentation is delayed, then ophthalmological complications of pseudotumor cerebri can be avoided by administration of a combination of acetazolamide, dexamethasone, lumbar puncture, and possibly lumboperitoneal shunt placement.

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Dural arteriovenous fistulas masquerading as dural sinus thrombosis

Journal of Neurosurgery ◽

10.3171/2008.7.jns08253 ◽

2009 ◽

Vol 110 (3) ◽

pp. 514-517 ◽

Cited By ~ 4

Author(s):

Scott Simon ◽

Tom Yao ◽

Arthur J. Ulm ◽

Benjamin P. Rosenbaum ◽

Robert A. Mericle

Keyword(s):

Sinus Thrombosis ◽

Noninvasive Imaging ◽

Anticoagulation Therapy ◽

Transverse Sinus ◽

Dural Sinus ◽

Dural Sinus Thrombosis ◽

Venous Flow ◽

Arteriovenous Fistulas ◽

Imaging Results ◽

Dural Arteriovenous Fistulas

The authors report dural sinus thrombosis diagnosed in 2 patients based on noninvasive imaging results, which were revealed to be dural arteriovenous fistulas (DAVFs) diagnosed using digital subtraction (DS) angiography. The first patient was a 63-year-old man who presented with headaches. Magnetic resonance venography was performed and suggested dural sinus thrombosis of the left transverse sinus and jugular vein. He was administered warfarin anticoagulation therapy but then suffered multiple intracranial hemorrhages. A DS angiogram was requested for a possible dural sinus thrombectomy, but the DS angiogram revealed a DAVF. The patient underwent serial liquid embolization with complete obliteration of the DAVF. The second patient, an 11-year-old boy, also presented with headaches and was diagnosed with dural sinus thrombosis on MR imaging. A DS angiogram was also requested for a possible thrombectomy and revealed a DAVF. This patient underwent serial liquid embolization and eventual operative resection. These reports emphasize that different venous flow abnormalities can appear similar on noninvasive imaging and that proper diagnosis is critical to avoid contraindicated therapies.

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Management and outcome of spontaneous cerebral venous sinus thrombosis in a 5-year consecutive single-institution cohort

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2015-012237 ◽

2016 ◽

Vol 9 (1) ◽

pp. 34-38 ◽

Cited By ~ 22

Author(s):

Darrin J Lee ◽

Arjang Ahmadpour ◽

Tamar Binyamin ◽

Brian C Dahlin ◽

Kiarash Shahlaie ◽

...

Keyword(s):

Superior Sagittal Sinus ◽

Sinus Thrombosis ◽

Anticoagulation Therapy ◽

Transverse Sinus ◽

Cerebral Venous Sinus Thrombosis ◽

Venous Sinus ◽

Dural Sinus ◽

Venous Sinus Thrombosis ◽

Sagittal Sinus ◽

The Impact

BackgroundCerebral 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.MethodsIn this retrospective review, we describe the 5-year UC Davis experience with spontaneous CVST.ResultsForty-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).ConclusionsIn 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.

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Dural Sinus Thrombosis Complicating Subclavian Vein Catheterization: Treatment With Local Thrombolysis

PEDIATRICS ◽

10.1542/peds.95.1.138 ◽

1995 ◽

Vol 95 (1) ◽

pp. 138-140

Author(s):

Bassam M. Gebara ◽

Mark G. Goetting ◽

Ay-Ming Wang

Keyword(s):

Internal Jugular Vein ◽

Subclavian Vein ◽

Jugular Vein ◽

Sinus Thrombosis ◽

Transverse Sinus ◽

Dural Sinus ◽

Dural Sinus Thrombosis ◽

Jugular Vein Thrombosis ◽

Vein Thrombosis ◽

Vein Catheterization

Local venous thrombosis is a known complication of subclavian vein catheterization.1,2 The clot can extend to the noncatheterized ipsilateral internal jugular vein.3,4 It is usually asymptomatic, however, signs of venous congestion can occur. Dural sinus thrombosis has been reported in association with retrograd catheterization of the internal jugular vein,5 but not the subclavian vein. We report a case of symptomatic right sigmoid sinus, transverse sinus, and bilateral internal jugular vein thrombosis without subclavian vein thrombosis in an infant few hours after placement of right subclavian vein catheter. CASE REPORT A 9-week-old girl was seen in the emergency room for lethargy, cyanosis, and apnea.

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Direct Endovascular Thrombolytic Therapy for Dural Sinus Thrombosis

Neurosurgery ◽

10.1227/00006123-199101000-00019 ◽

1991 ◽

Vol 28 (1) ◽

pp. 135-142 ◽

Cited By ~ 78

Author(s):

Stanley L. Barnwell ◽

Randall T. Higashida ◽

Van V. Halbach ◽

Christopher F. Dowd ◽

Grant B. Hieshima

Keyword(s):

Sinus Thrombosis ◽

Clinical Signs ◽

Signs And Symptoms ◽

Transverse Sinus ◽

Clinical Findings ◽

Dural Sinus ◽

Clot Lysis ◽

Dural Sinus Thrombosis ◽

Patients Âgés ◽

Cranial Nerve Palsies

Abstract Three patients, ages 51 to 71 years, sought treatment for symptomatic dural sinus thrombosis with occlusion and were treated by direct sinus perfusion with urokinase. All three patients had a dural arteriovenous fistula; one involved the inferior petrosal sinus and two involved the transverse sinus. Clinical findings included papilledema, diminished visual acuity, decreased mentation, and cranial nerve palsies. Diagnosis was made by cerebral arteriography and confirmed by sinus venography. All three patients were treated by a transjugular direct infusion of urokinase. In one patient, a transfemoral venous approach used initially was discontinued because of an infection. The period of continuous infusion for thrombolysis ranged between 4 and 10 days. In two patients, the clinical signs and symptoms improved with angiographic evidence of clot lysis and dural sinus recanalization. Angiography indicated that one patient had a partial resolution of a clot in the torcular herophili and transverse sinus but showed no clinical improvement. These preliminary results suggest that transjugular local infusion of thrombolytic agents can be an effective treatment for symptomatic, thrombosed dural sinuses. This selective lysis avoids thrombolytic effects that could aggravate or produce systemic hemorrhagic complications.

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Cerebellar cortical vein thrombosis mimicking a vermian tumor: case report

The Neuroradiology Journal ◽

10.1177/1971400917725760 ◽

2017 ◽

Vol 31 (3) ◽

pp. 309-312 ◽

Cited By ~ 2

Author(s):

Marcelo D Vilela ◽

Hugo AS Pedrosa ◽

Marco Antonio D Filho

Keyword(s):

Case Report ◽

Sinus Thrombosis ◽

Cerebellar Hemisphere ◽

Dural Sinus ◽

Cerebellar Tumor ◽

Dural Sinus Thrombosis ◽

Venous Infarction ◽

Cortical Vein ◽

Vein Thrombosis ◽

Cortical Vein Thrombosis

Cortical vein thrombosis is an uncommon cause of stroke and generally occurs in the supratentorial compartment. Spontaneous venous thrombosis with infarction in the posterior fossa usually occurs in association with either dural sinus thrombosis and/or thrombosis of the petrosal vein, usually with venous infarction of the cerebellar hemisphere. Our goal is to present the case of a patient with thrombosis of cerebellar cortical veins, without sinus involvement, which mimicked a vermian cerebellar tumor.

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Treatment of dural sinus thrombosis with local urokinase infusion

Journal of Neurosurgery ◽

10.3171/jns.1988.68.2.0284 ◽

1988 ◽

Vol 68 (2) ◽

pp. 284-287 ◽

Cited By ~ 103

Author(s):

John A. Scott ◽

Robert M. Pascuzzi ◽

Peter V. Hall ◽

Gary J. Becker

Keyword(s):

Intravenous Infusion ◽

Sinus Thrombosis ◽

Anticoagulation Therapy ◽

Current Therapy ◽

Dural Sinus ◽

Dural Sinus Thrombosis ◽

Content Type ◽

Aggressive Therapy ◽

Urokinase Infusion ◽

Fine Print

✓ Current therapy for dural sinus thrombosis consists of supportive measures, anticoagulation therapy, and in some cases intravenous infusion of a fibrinolytic agent. A patient with extensive dural sinus thrombosis was successfully treated with local urokinase infusion. The technique and rationale for this aggressive therapy are discussed.

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Dural Sinus Thrombosis after Translabyrinthine Approach for Vestibular Schwannomas

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0034-1383972 ◽

2014 ◽

Vol 75 (S 02) ◽

Author(s):

Ashish Kumar ◽

F. Pirouzmand ◽

J. Chen

Keyword(s):

Sinus Thrombosis ◽

Vestibular Schwannomas ◽

Dural Sinus ◽

Dural Sinus Thrombosis ◽

Translabyrinthine Approach

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Extensive Experience with Dural Sinus Thrombosis

Neurosurgery ◽

10.1227/01.neu.0000047815.21786.c1 ◽

2003 ◽

Vol 52 (3) ◽

pp. 534-544 ◽

Cited By ~ 84

Author(s):

Scott W. Soleau ◽

Richard Schmidt ◽

Steve Stevens ◽

Anne Osborn ◽

Joel D. MacDonald

Keyword(s):

Clinical Improvement ◽

Sinus Thrombosis ◽

Treatment Strategies ◽

Retrospective Chart Review ◽

Dural Sinus ◽

Hemorrhagic Complication ◽

Dural Sinus Thrombosis ◽

Extensive Experience ◽

Medical Observation ◽

Hemorrhagic Complications

Abstract OBJECTIVE Dural sinus thrombosis (DST) is an uncommon cause of stroke. The safest and most effective therapy for DST has not been conclusively identified. METHODS A retrospective chart review of data for 31 patients who were treated for DST at our institution between 1992 and 2001 was performed. Four treatment strategies were identified, i.e., 1) medical observation only, 2) systemic anticoagulation (AC) therapy with heparin, 3) endovascular chemical thrombolysis with urokinase or tissue plasminogen activator and concurrent systemic AC therapy, and 4) mechanical endovascular clot thrombolysis with concurrent systemic AC therapy. Complications and clinical outcomes were assessed for each group. RESULTS Patients treated solely with medical observation fared the worst; four of five patients experienced intracranial hemorrhagic complications, and only two of five exhibited clinical improvement. Patients who received systemic AC therapy experienced no hemorrhagic complications, even when pretreatment hemorrhage was present; 75% (six of eight patients) exhibited improvement with AC therapy alone. Chemical thrombolysis was very effective in restoring sinus patency (90% of patients); however, 30% of patients (3 of 10 patients) experienced hemorrhagic complications. Sixty percent of patients (6 of 10 patients) who underwent chemical thrombolysis exhibited clinical improvement. Patients who underwent mechanical thrombectomies demonstrated a low hemorrhagic complication rate, and most (88%) made good recoveries. CONCLUSION Therapy directed at the underlying clot in DST must begin without delay. Our results suggest that supportive medical management of DST, without therapy directed at the clot or clotting process, is not effective. Systemic AC therapy, even in the presence of intracerebral hemorrhage, seems to be safe. Heparin can be safely titrated to yield partial thromboplastin times of 60 to 70 seconds. Chemical clot thrombolysis is efficacious in opening occluded sinuses but may cause intracranial hemorrhage. We currently recommend either systemic AC therapy or systemic AC therapy in conjunction with mechanical clot thrombectomy as a safe effective treatment for DST.

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