Kow Chien Yew, Caldwell James, Mchugh Frances, Sillars Hamish, Bok Arnold
Neurosurgery Department, Auckland City Hospital, Auckland, New Zealand.
Radiology Department, Auckland City Hospital, Auckland, New Zealand.
J Clin Neurosci. 2020 May;75:157-162. doi: 10.1016/j.jocn.2019.12.036. Epub 2020 Mar 12.
Dural venous sinus thrombosis is an uncommon, but significant sequela that may occur after resection of a cerebellopontine angle lesion. The natural history and management of this pathology has not been sufficiently studied.
All operative cases for cerebellopontine angle lesions performed in our local institution dating from 1 January 2005 to 30 June 2018 were retrospectively reviewed to identify patients who developed new post-operative dural venous sinus thrombosis. Patients who developed a significantly narrowed sinus without intrinsic thrombus were also identified. Progression of sinus thrombosis through time was followed, with comparisons made between complications amongst patients with and without a compromised sinus.
Of the 126 patients, 20 were found to have new sinus thrombosis, with another 16 developing a critically narrowed sinus without intrinsic thrombus. These cases are significantly associated with translabyrinthine resection of acoustic schwannoma. 4 patients amongst the thrombosed group were commenced on additional therapeutic anticoagulation or antiplatelets, whilst the rest were observed. Based on available follow up imaging, 10/17 patients had significantly improved sinus thrombosis on serial imaging, including 8/14 amongst those not given additional anticoagulation. Patients with a compromised sinus demonstrated a higher rate of cerebrospinal fluid leak requiring blindsac procedures. When involving a dominant sinus, there is also an association of an increased requirement for permanent CSF diversion.
Therapeutic anticoagulation should be considered for symptomatic post-operative dural venous sinus thrombosis or if it involves a dominant sinus. Further prospective studies are warranted to better elucidate the risk-benefit justification of treatment for postoperative sinus thrombosis.
硬脑膜静脉窦血栓形成是一种不常见但严重的后遗症，可能发生在桥小脑角病变切除术后。这种病理状况的自然病程和治疗方法尚未得到充分研究。
回顾性分析了2005年1月1日至2018年6月30日在我们当地机构进行的所有桥小脑角病变手术病例，以确定术后发生新的硬脑膜静脉窦血栓形成的患者。还确定了那些窦明显狭窄但无内在血栓形成的患者。随访观察窦血栓形成随时间的进展情况，并对窦有无受损的患者的并发症进行比较。
在126例患者中，20例被发现有新的窦血栓形成，另有16例出现窦严重狭窄但无内在血栓形成。这些病例与听神经瘤的经迷路切除术显著相关。血栓形成组中有4例患者开始接受额外的治疗性抗凝或抗血小板治疗，其余患者则进行观察。根据现有的随访影像学检查，17例患者中有10例在系列影像学检查中窦血栓形成有明显改善，其中未接受额外抗凝治疗的14例中有8例。窦受损的患者脑脊液漏需要进行盲袋手术的发生率更高。当累及优势窦时，永久性脑脊液分流的需求也会增加。
对于有症状的术后硬脑膜静脉窦血栓形成或累及优势窦的情况，应考虑进行治疗性抗凝。有必要进行进一步的前瞻性研究，以更好地阐明术后窦血栓形成治疗的风险效益依据。
