Pediatric cerebral sinovenous thrombosis following cranial surgery.
Publication/Presentation Date
3-1-2017
Abstract
PURPOSE: Pediatric cerebral sinovenous thrombosis (CSVT) is an important, though less common subtype of pediatric stroke. It has been linked to several risk factors, including cranial procedures, with few studies highlighting this relationship. The aim of this study was to characterize the diagnosis and treatment of CSVT after cranial surgery.
METHODS: An institutional pediatric stroke research database was used to identify all CSVT cases diagnosed within 30 days of cranial surgery from November 2004 to December 2014. Thirteen subjects were retrospectively analyzed for clinical presentation, surgical details, radiographic characteristics, laboratory study results, treatment, and outcome. Diagnostic testing and treatment adhered to a consensus-based institutional stroke protocol.
RESULTS: Cranial vault reconstruction, subdural empyema evacuation, and tumor resection were each observed in three subjects. Eleven (85%) subjects had sinus exposure during surgery, and eight (73%) developed thrombus in a sinus within or adjacent to the operative field. Two (15%) had documented iatrogenic sinus injury. On post-operative testing, ten (77%) subjects had prothrombotic abnormalities. Seven (54%) were treated with anti-coagulation therapy (ACT) starting on a median of post-operative day (POD) 3 (IQR 1-3) for a median of 2.9 months (IQR 2.4-5.4). Median time to imaging evidence of partial or complete recanalization was 2.4 months (IQR 0.7-5.1). No symptomatic hemorrhagic complications were encountered.
CONCLUSIONS: Pediatric CSVT may be encountered after cranial surgery, and decisions related to anti-coagulation are challenging. The risk of CSVT should be considered in pre-surgical planning and post-operative evaluation of cases with known risk factors. In our study, judicious use of ACT was safe in the post-operative period.
Volume
33
Issue
3
First Page
491
Last Page
497
ISSN
1433-0350
Published In/Presented At
Petrov, D., Uohara, M. Y., Ichord, R., Ali, Z., Jastrzab, L., Lang, S. S., & Billinghurst, L. (2017). Pediatric cerebral sinovenous thrombosis following cranial surgery. Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery, 33(3), 491–497. https://doi.org/10.1007/s00381-016-3329-2
Disciplines
Medicine and Health Sciences | Pediatrics
PubMedID
28091816
Department(s)
Department of Pediatrics
Document Type
Article