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Published on: October 20, 2017
Management of paediatric otogenic cerebral venous sinus thrombosis: a systematic review
B Y W Wong1, S Hickman1, M Richards2
1Department of ENT, Pinderfields General Hospital, Wakefield, UK.
Insights
Conservative otological surgery combined with anticoagulation appears to be the most common treatment for paediatric otogenic cerebral venous sinus thrombosis (CVST) with good outcomes. Further multicentre studies are needed to confirm optimal management strategies for this rare condition.
Area of Science:
- Pediatric Neurology
- Otolaryngology
- Vascular Neurology
Background:
- Otogenic cerebral venous sinus thrombosis (CVST) is a rare but serious condition in children.
- Management strategies, particularly the roles of surgery and anticoagulation, remain debated.
Purpose of the Study:
- To systematically review the literature on the medical and surgical management of paediatric otogenic CVST.
- To examine the clinical and radiological outcomes associated with different treatment approaches.
Main Methods:
- A systematic review of studies indexed in MEDLINE, EMBASE, and Cochrane databases up to November 2014.
- Inclusion of 36 studies (15 case reports, 21 case series) involving 190 paediatric patients.
- Data extraction focused on otological surgery type and anticoagulant use, correlating with clinical and radiological outcomes.
Main Results:
- Over 92% of patients underwent otological surgery, with conservative approaches being more common (69.5%).
- Anticoagulants were administered to 59% of patients, and 79.2% achieved a good clinical outcome.
- Conservative surgery with anticoagulation was associated with good outcomes in 56% of patients; complete recanalisation occurred in 51% of all patients.
Conclusions:
- Conservative otological surgery combined with anticoagulation is frequently associated with favorable clinical outcomes in paediatric otogenic CVST.
- The current evidence level is low, necessitating multicentre collaborative studies.
- Further research is required to establish optimal surgical and anticoagulation strategies for paediatric otogenic CVST.
Background:
Otogenic paediatric cerebral venous sinus thrombosis (CVST) is rare but has potential clinical sequelae. Its management has long been debated mainly concerning the role of surgery and the use of anticoagulant therapy.
Objective Of Review:
To review the current literature and examine the medical and surgical management of paediatric otogenic CVST and its clinical and radiological outcome.
Type Of Review:
Systematic review.
Search Strategy:
The electronic databases (MEDLINE, EMBASE, Cochrane) were searched from inception to November 2014 using text words 'cerebral venous sinus thrombosis OR cerebral venous thrombosis OR lateral sinus thrombosis OR sigmoid sinus thrombosis' AND 'otogenic OR mastoiditis OR otitis media' AND 'children OR paediatric OR pediatric'.
Evaluation Method:
Inclusion criteria were applied by two reviewers and data extraction was carried out. The type of otological surgery (conservative versus extensive) and the use of anticoagulants with their clinical and radiological outcomes were tabulated.
Results:
Thirty-six studies (15 case reports and 21 case series) were included with a total of 190 patients. A total of 92.1% of patients underwent otological surgery, and 69.5% had conservative surgery and 30.5% extensive otological surgery. Anticoagulants were used in 59%. A total of 79.2% of patients were reported to have had a good clinical outcome. Within this group, 56% had conservative surgery and anticoagulants. Follow-up scans were documented in 61.6% of patients and complete recanalisation was observed in 51%. Complete recanalisation was observed in 47% of those who had been anticoagulated and 55% of those who received no anticoagulation.
Conclusions:
Conservative otological surgery with the combination of anticoagulation was the most common treatment modality found in the group of patients with good clinical outcome. However, given the current low level of evidence, a multicentre collaborative study is needed to help establish the optimum surgical approach and the role of anticoagulation in managing paediatric otogenic CVST.
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