Presentation and management of lateral sinus thrombosis following posterior fossa surgery
| Autor: | Catherine Oppenheim, Johan Pallud, Jean-François Meder, Bertrand Devaux, Caroline Apra, R Souillard-Scemama, Eduardo Parraga, Owais Kotbi, Xavier Sauvageon, Mélanie Pagès, Guillaume Turc, Edouard Dezamis, Robert Corns |
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| Přispěvatelé: | Gestionnaire, Hal Sorbonne Université, Université Sorbonne Paris Cité (USPC), Université Paris Descartes - Paris 5 (UPD5), Institut de psychiatrie et neurosciences (U894 / UMS 1266), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Leeds General Infirmary (LGI), Leeds Teaching Hospitals NHS Trust, Centre Hospitalier Sainte Anne [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP) |
| Rok vydání: | 2016 |
| Předmět: |
Male
[SDV.MHEP.CHI] Life Sciences [q-bio]/Human health and pathology/Surgery Infratentorial Neoplasms 030204 cardiovascular system & hematology surgery Sinus Thrombosis Intracranial 0302 clinical medicine Postoperative Complications Risk Factors Medicine lateral sinus anticoagulation Sinus (anatomy) Aged 80 and over Incidence (epidemiology) Incidence posterior fossa General Medicine Middle Aged Thrombosis Magnetic Resonance Imaging 3. Good health Venous thrombosis medicine.anatomical_structure [SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC] Female medicine.symptom Presentation (obstetrics) Adult medicine.medical_specialty Oral contraceptive pill Adolescent [SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery vascular disorders Lesion 03 medical and health sciences Young Adult Humans [SDV.NEU] Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC] thrombosis Lateral Sinus Thrombosis Aged Retrospective Studies business.industry Anticoagulants medicine.disease Surgery business Tomography X-Ray Computed 030217 neurology & neurosurgery |
| Zdroj: | Journal of Neurosurgery Journal of Neurosurgery, American Association of Neurological Surgeons, 2017, 126 (1), pp.8-16. ⟨10.3171/2015.11.JNS151881⟩ |
| ISSN: | 1933-0693 0022-3085 |
| Popis: | OBJECTIVE There are no guidelines for the management of postoperative lateral sinus thrombosis following posterior fossa surgery. Introducing treatment-dose anticoagulant therapy during the immediate postoperative period increases the risk of intracranial bleeding. This study assessed the incidence of and risk factors associated with postoperative lateral sinus thrombosis and the complications related to thrombosis and/or anticoagulation. METHODS This study was a retrospective monocentric analysis of adult patients who underwent surgical removal of a posterior fossa space-occupying lesion with available postoperative imaging. Postoperative lateral sinus thrombosis was defined as a T2* hypointensity within the venous sinus and/or a filling defect on postcontrast MRI or CT scan. RESULTS Among 180 patients, 12 (6.7%; 95% CI 3.0–10.4) were found to have lateral sinus thrombosis on postoperative imaging, none of whom were symptomatic. Unadjusted risk factors for postoperative lateral sinus thrombosis were a history of deep venous thrombosis (p = 0.016), oral contraceptive pill (p = 0.004), midline surgical approach (p = 0.035), and surgical exposure of the sinus (p < 0.001). Seven of the patients (58.3%) with a postoperative lateral sinus thrombosis received immediate treatment-dose anticoagulant therapy. Lateral sinus recanalization occurred radiologically at a mean time of 272 ± 23 days in 85.7% of patients (6 of 7) undergoing treatment-dose anticoagulant therapy and in 20% of patients (1 of 5) not receiving treatment-dose anticoagulant therapy. Postoperative complications occurred in 56.2% of patients (9 of 16) who received treatment-dose curative anticoagulant therapy and in 27% of patients (45 of 164) who did not. CONCLUSIONS Incidental radiological lateral sinus thrombosis following posterior fossa surgery has an incidence of 6.7%. To further define the benefit-to-risk ratio of a treatment-dose anticoagulant therapy, a prospective trial should be considered. |
| Databáze: | OpenAIRE |
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