Risk factors governing the development of cerebral vein and dural sinus thrombosis after craniotomy in patients with intracranial tumors

OBJECTIVENeurosurgical 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.METHODSA 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.RESULTSOf 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.CONCLUSIONSOnly 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.

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Risk factors for remote seizure development in patients with cerebral vein and dural sinus thrombosis

Seizure ◽

10.1016/j.seizure.2013.10.011 ◽

2014 ◽

Vol 23 (2) ◽

pp. 135-139 ◽

Cited By ~ 23

Author(s):

Vahid Davoudi ◽

Kiandokht keyhanian ◽

Mohammad Saadatnia

Keyword(s):

Risk Factors ◽

Sinus Thrombosis ◽

Dural Sinus ◽

Cerebral Vein ◽

Dural Sinus Thrombosis

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Clinical Profile, Risk Factors for Presenting Seizures in Cerebral Vein and Dural Sinus Thrombosis

International Journal of Neurology and Neurosurgery ◽

10.21088/ijnns.0975.0223.10418.9 ◽

2018 ◽

Vol 10 (4) ◽

pp. 145-149

Author(s):

Sagar Badachi ◽

Keyword(s):

Risk Factors ◽

Sinus Thrombosis ◽

Clinical Profile ◽

Dural Sinus ◽

Cerebral Vein ◽

Dural Sinus Thrombosis

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Abstract WP225: Prognosis of Cerebral Venous Thrombosis and Provoking Risk Factors

Stroke ◽

10.1161/str.47.suppl_1.wp225 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Eun-Jae Lee ◽

Sang-Mi Noh ◽

Dong-Wha Kang ◽

Jong S Kim ◽

Sun U Kwon

Keyword(s):

Risk Factors ◽

Sinus Thrombosis ◽

Medical Center ◽

Underlying Disease ◽

Term Treatment ◽

Dural Sinus ◽

Cerebral Vein ◽

Long Term Treatment ◽

Baseline Characteristics

Background and hypothesis: Little is known about the relationships between the presence/type of provoking risk factors and the prognosis and optimal duration of anticoagulation in patients with cerebral vein and dural sinus thrombosis (CVT). We aimed to analyze data of treatment and long-term prognosis in patients with CVT classified by the presence and type of provoking risk factors. Methods: Prospectively recorded data of a tertiary medical center were retrospectively reviewed. Patients with CVT were categorized into three groups by risk factors: unprovoked, those with possibly resolved provoking factors (PR), and those with persistent provoking factors (PP). The baseline characteristics, treatment, and prognosis of these three groups were analyzed. Results: From 2000 to 2015, 61 patients were registered for CVT, 19 (31.1%) with unprovoked, 11 (18.0%) with PR, and 31 (50.9%) with PP. Median follow-up and duration of anticoagulation were 35 and 8 months, respectively. The PR group consisted of patients with causative drugs or arteriovenous fistula successfully treated. Despite the similarities in baseline characteristics of the three groups, deaths (n=3; P = 0.256) and recurrences (n=7; P = 0.020) were observed only in the PP group. The median interval to death and recurrence were 9 and 13 months, respectively. Death was associated with underlying disease activity, not with CVT progression. Recurrences were associated with lack of initial administration of anticoagulation (P = 0.028); of the seven patients with recurrence, five (71.4%) did not receive anticoagulation at the second event. Conclusions: Although the prognosis of CVT is generally benign, recurrence and death were observed in the patients with persistent risk factors, suggesting their need for long-term treatment with anticoagulants.

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Low molecular weight heparin therapy in pediatric otogenic sigmoid sinus thrombosis: A safe treatment option?

International Journal of Pediatric Otorhinolaryngology ◽

10.1016/j.ijporl.2012.03.024 ◽

2012 ◽

Vol 76 (7) ◽

pp. 1023-1026 ◽

Cited By ~ 20

Author(s):

Thorsten Ropposch ◽

Ulrike Nemetz ◽

Eva Maria Braun ◽

Andreas Lackner ◽

Christian Walch

Keyword(s):

Molecular Weight ◽

Treatment Option ◽

Low Molecular Weight Heparin ◽

Sinus Thrombosis ◽

Heparin Therapy ◽

Sigmoid Sinus ◽

Low Molecular Weight ◽

Safe Treatment ◽

Safe Treatment Option

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Evaluation and Management of Women who Have Experienced Stillbirth in Their Previous Pregnancies

Gynecology Obstetrics and Reproductive Medicine ◽

10.21613/gorm.2018.892 ◽

2019 ◽

pp. 1

Author(s):

Erdem Fadiloglu ◽

Atakan Tanacan ◽

Canan Unal ◽

Mehmet Sinan Beksac

Keyword(s):

Risk Factors ◽

Molecular Weight ◽

Low Molecular Weight Heparin ◽

Low Dose ◽

Methylenetetrahydrofolate Reductase ◽

Post Partum ◽

Subsequent Pregnancy ◽

Low Molecular Weight ◽

Mthfr Polymorphisms ◽

The Mean

Objective: To evaluate the subsequent pregnancy outcomes of women who have experienced unexplained stillbirth in their previous gestations.Study Design: This retrospective cohort consisted of 14 pregnancies who had stillbirth (without known risk factors) in their previous pregnancies. These patients had been included in a special preconceptional care program to be evaluated in terms of etiological risk factors for stillbirth. At least one of the risk factors, such as methylenetetrahydrofolate reductase (MTHFR) polymorphisms, hereditary thrombophilias and autoimmune problems, were defined in this study population. After detection of pregnancy, the patients were administered low-dose low-molecular-weight heparin (LMWH) (enoxaparin, 1×2000 Anti-XA IU/0.2 mL/day), low-dose salicylic acid (100 mg/day) and low-dose corticosteroid (methylprednisolone, 1×4 mg/day orally) in necessary cases.Results: Out of 14 pregnancies, 4 (28.5%) ended up with miscarriages at 9, 11, 11 and 15 gestational weeks, respectively. The remaining 10 pregnancies ended up with alive deliveries. The mean gestational week at birth was 36.4±0.51, while the mean birthweight was 2882±381.01 g. Out of 10 pregnancies, only one was diagnosed as IUGR. Only two newborn necessitated hospitalization in the neonatal intensive care unit (NICU) due to respiratory problems. Both newborns were discharged from the NICU without any further complication at the post-partum 5th day. Conclusion: Patients with a prior stillbirth should be screened for MTHFR polymorphisms, autoimmune problems and hereditary thrombophilias, especially in case of absence of any etiological factor. Management of these patients with low-dose aspirin, low-dose low molecular weight heparin and corticosteroids seemed to be beneficial for increasing live birth rates and avoiding obstetric complications.

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