Orlev Alon, Jackson Christopher M, Luksik Andrew, Garzon-Muvdi Tomas, Yang Wuyang, Chien Wade, Harnof Sagi, Tamargo Rafael J
Department of Neurosurgery, Rabin Medical Center, Petach Tikva, Israel.
Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland.
Oper Neurosurg. 2020 Aug 1;19(2):109-116. doi: 10.1093/ons/opz396.
Transverse or sigmoid sinus thrombosis occurs in 4% to 11% of patients following posterior fossa surgery. Anticoagulation has been the mainstay treatment, mostly based on extrapolation from the literature on spontaneous sinus thrombosis.
To analyze the rate and associated complications of postoperative transverse/sigmoid sinus thrombosis for patients undergoing posterior fossa tumor resection. In this series, no antithrombotic therapy was initiated, and no postoperative treatment alterations were made following thrombosis diagnosis.
Prospectively accrued cases from a single surgeon operating at a single academic center were retrospectively reviewed to determine the natural history of untreated transverse/sigmoid sinus thrombosis following posterior fossa surgery. Inclusion criteria were patients 18 yr or older undergoing resection of a posterior fossa tumor. A total of 538 patients were analyzed.
In all 26 out of 538 (4.8%) patients were diagnosed with transverse/sigmoid sinus thrombosis on routine postoperative imaging. Early postoperative complication rate was 38% in the sinus thrombosis group, as compared to 15% in the no-thrombosis group (P = .02). A significantly higher rate of pseudomeningocele, dysphagia requiring gastrostomy, and cerebellar stroke signs were noted in patients with postoperative sinus thrombosis. However, only 3 of the 26 patients (12%) with postoperative sinus occlusion suffered prolonged central nervous system complications.
Transverse/sigmoid sinus thrombosis following suboccipital craniectomy results in a higher rate of early complications; however, most of these complications resolve without anticoagulation. It may be reasonable, therefore, to manage these patients conservatively in order to avoid the risks associated with anticoagulation in the perioperative period.
后颅窝手术后4%至11%的患者会发生横窦或乙状窦血栓形成。抗凝一直是主要治疗方法，大多基于从自发性窦血栓形成的文献推断而来。
分析后颅窝肿瘤切除患者术后横窦/乙状窦血栓形成的发生率及相关并发症。在本系列研究中，未启动抗血栓治疗，血栓形成诊断后也未进行术后治疗调整。
回顾性分析来自单一学术中心的一位外科医生前瞻性积累的病例，以确定后颅窝手术后未经治疗的横窦/乙状窦血栓形成的自然病程。纳入标准为年龄18岁及以上接受后颅窝肿瘤切除术的患者。共分析了538例患者。
在538例患者中，共有26例（4.8%）在术后常规影像学检查中被诊断为横窦/乙状窦血栓形成。窦血栓形成组术后早期并发症发生率为38%，无血栓形成组为15%（P = 0.02）。术后窦血栓形成的患者中，假性脑膜膨出、需要胃造瘘的吞咽困难和小脑卒中体征的发生率显著更高。然而，26例术后窦闭塞患者中只有3例（12%）出现了长期的中枢神经系统并发症。
枕下开颅术后横窦/乙状窦血栓形成导致早期并发症发生率更高；然而，这些并发症大多无需抗凝即可缓解。因此，为避免围手术期抗凝相关风险，对这些患者进行保守治疗可能是合理的。
