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Bilateral Transverse Sinus Thrombosis following Craniotomy and Cranial Reconstruction for Sagittal Craniosynostosis
Aaron Mohanty1, Krystalynne Godwin2, Mohammad Fares Albitar3
1Department of Neurosurgery, University of Texas Medical Branch at Galveston, Galveston, Texas, USA, aarmohanty@yahoo.com.
Insights
Dural sinus thrombosis is a rare complication following craniotomy for craniosynostosis. Early anticoagulant treatment is recommended, and surgical techniques should aim to prevent direct sinus injury.
Area of Science:
- Neurosurgery
- Pediatric Surgery
- Vascular Surgery
Background:
- Craniotomy and cranial reconstruction are common procedures for pediatric craniosynostosis.
- Dural sinus thrombosis is an underreported complication after these surgeries.
Observation:
- A 2-year-old child developed bilateral transverse sinus thrombosis after craniotomy for sagittal craniosynostosis.
- The patient experienced pulmonary hemorrhage, acute respiratory distress syndrome, and neurological impairment.
Findings:
- Dural sinus thrombosis is a rare but serious complication of craniotomy.
- Anticoagulant therapy with low-molecular-weight heparin was initiated.
- Surgical prevention strategies include avoiding direct sinus injury and protecting the sinus during flap elevation.
Implications:
- Dural sinus thrombosis should be considered in the postoperative management of craniotomy patients.
- Prompt diagnosis and treatment with anticoagulants are crucial.
- Preventive surgical measures can reduce the risk of this complication.
Introduction:
Craniotomy and cranial reconstruction is the most common procedure for children older than 6 months with craniosynostosis. Dural sinus thrombosis after this surgery has not been well reported in the literature.
Case Presentation:
This 2-year-old child underwent a bilateral craniotomy and cranial reconstruction for sagittal craniosynostosis. He had a partial thickness tear of the wall of the right transverse sinus which was uneventfully managed. Postoperative imaging showed evidence of bilateral thrombosis of the transverse sinus with a small occipital hemorrhage. He was started on low-molecular-weight heparin. Follow-up imaging showed nonprogression of the thrombosis. Four days later, he developed pulmonary hemorrhage, had an extended period of low oxygenation and hypotension with acute respiratory distress syndrome, and had to be ventilated for a prolonged period. Follow-up MRI showed evidence of extensive bilateral cortical hypointensities possibly due to hypoxemia. At the last follow-up, he continued to be grossly neurologically impaired.
Conclusion:
Thrombosis of the dural sinuses is a very rare occurrence after an extensive craniotomy and cranial reconstruction. However, it should be considered during the postoperative period and, if diagnosed, it should be treated with anticoagulants. Avoiding a direct sinus injury during reflection of the craniotomy flap and covering the exposed sinus with moist cottonoids during the surgery is advocated to prevent sinus thrombosis.
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