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Pediatric otogenic lateral sinus thrombosis recanalization
Ryan E Neilan1, Brandon Isaacson, J Walter Kutz
1Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390-9035, USA.
Insights
Pediatric patients with otogenic lateral sinus thrombosis showed significant recanalization of the lateral intracranial venous sinus. Recovery outcomes were observed, though the roles of surgery and anticoagulation require further study.
Area of Science:
- Neurology
- Pediatric Otolaryngology
- Vascular Imaging
Background:
- Otogenic lateral sinus thrombosis is a rare but serious complication of middle ear infections in children.
- Internal jugular vein thrombosis can accompany lateral sinus thrombosis, potentially leading to increased intracranial pressure.
Purpose of the Study:
- To investigate the recovery outcomes in pediatric patients diagnosed with otogenic lateral sinus and internal jugular vein thrombosis.
- To analyze the extent of thrombosis, interventions, and recanalization rates.
Main Methods:
- A retrospective review of an inpatient database from 1999-2010 at a tertiary pediatric hospital.
- Inclusion criteria: diagnosis code for thrombosis of intracranial venous sinus.
- Data collected: demographics, thrombosis extent, surgical interventions, anticoagulation, and follow-up imaging for recanalization.
Main Results:
- Fifteen pediatric patients with otogenic lateral sinus thrombosis were identified.
- Thrombosis involved the transverse sinus (73.3%) and internal jugular vein (66.7%).
- Eighty percent underwent operative intervention; 80% received anticoagulation. Seventy-one percent showed recanalization on follow-up imaging. All five with otitic hydrocephalus recovered.
Conclusions:
- Recanalization of the lateral intracranial venous sinus is common in pediatric patients with otogenic thrombosis.
- The specific roles of operative intervention and anticoagulation in recovery remain uncertain and warrant further investigation.
Objective:
To describe the recovery outcomes in pediatric patients with otogenic lateral sinus and internal jugular vein thrombosis.
Methods:
An inpatient database from a tertiary care pediatric hospital was queried from 1999 to 2010 for the diagnosis code [325] thrombosis of intracranial venous sinus. Demographics, extent of thrombosis, surgical intervention, use of anticoagulation, and the presence of recanalization on follow-up imaging was collected.
Results:
Fifteen patients (10 male, 5 female) were identified with otogenic lateral sinus thrombosis. Eleven patients (73.3%) had evidence of thrombus in the transverse sinus, while 10 patients (66.7%) had thrombus in the internal jugular vein, and one patient (6.7%) had thrombus in the cavernous sinus. Five patients (33%) had otitic hydrocephalus. Twelve patients (80%) underwent operative manipulation of the lateral sinus including: three decompressions 20%, three needle aspirations 20%, and six venotomies with evacuation of clot or pus 40%. Twelve patients were anticoagulated with low molecular weight heparin, and three patients were not anticoagulated. Ten of fourteen patients (71.4%) who underwent follow-up magnetic resonance venography had evidence of partial (57.1%) or complete (14.3%) recanalization of the lateral sinus. All five patients with otitic hydrocephalus recovered as determined by a normal fundoscopic exam and recovery of abducens paresis.
Conclusion:
Recanalization of the lateral intracranial venous sinus occurred in the majority of the patients in this series. The role of operative intervention and/or anticoagulation remains unclear.
