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Published on: October 20, 2017
Pediatric cerebral sinovenous thrombosis following cranial surgery
Dmitriy Petrov1, Michael Y Uohara2, Rebecca Ichord3
1Department of Neurosurgery, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA.
Insights
Pediatric cerebral sinovenous thrombosis (CSVT) can occur after cranial surgery. Judicious use of anticoagulation therapy (ACT) was found to be safe and effective in managing CSVT in this patient group.
Area of Science:
- Neurology
- Pediatric Stroke
- Cerebrovascular Diseases
Background:
- Pediatric cerebral sinovenous thrombosis (CSVT) is a less common but significant type of pediatric stroke.
- Cranial procedures are identified as potential risk factors for CSVT, yet this relationship requires further characterization.
- Understanding CSVT post-neurosurgery is crucial for effective patient management.
Purpose of the Study:
- To characterize the diagnosis and treatment of pediatric cerebral sinovenous thrombosis (CSVT) following cranial surgery.
- To identify the incidence and clinical presentation of CSVT in pediatric patients post-cranial procedures.
- To evaluate the safety and efficacy of anticoagulation therapy (ACT) in managing post-operative CSVT.
Main Methods:
- Retrospective analysis of a pediatric stroke research database (November 2004 - December 2014).
- Inclusion criteria: pediatric patients diagnosed with CSVT within 30 days of cranial surgery.
- Data collected: clinical presentation, surgical details, radiographic findings, laboratory results, treatment, and outcomes, adhering to institutional stroke protocols.
Main Results:
- Cranial vault reconstruction, subdural empyema evacuation, and tumor resection were the most common procedures.
- Sinus exposure during surgery was frequent (85%), with thrombus formation often adjacent to the operative field (73%).
- Prothrombotic abnormalities were common (77%); anticoagulation therapy (ACT) was initiated on median POD 3 and was safe, with no symptomatic hemorrhagic complications.
Conclusions:
- Pediatric CSVT is a potential complication following cranial surgery.
- Anticoagulation therapy (ACT) decisions in post-operative CSVT require careful consideration.
- The risk of CSVT should be integrated into pre-surgical planning and post-operative evaluations for at-risk pediatric patients.
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.
