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Postoperative Cerebral Venous Sinus Thrombosis Following a Retrosigmoid Craniotomy-A Clinical and Radiological
Lukasz Przepiorka1, Katarzyna Wójtowicz1, Katarzyna Camlet1
1Department of Neurosurgery, Medical University of Warsaw, 02-097 Warsaw, Poland.
Brain Sciences
|July 29, 2023
Summary
Postoperative cerebral venous sinus thrombosis (CVST) is rare after retrosigmoid surgery. Lower exposure of the transverse sinus and surgery on the dominant side correlated with radiological CVST, suggesting these factors may increase risk.
Area of Science:
- Neurosurgery
- Vascular Neurology
- Radiology
Background:
- Cerebral venous sinus thrombosis (CVST) is a rare but serious complication following neurosurgical procedures.
- The retrosigmoid approach, commonly used for posterior fossa pathologies, carries a risk of iatrogenic injury or thrombosis in adjacent venous sinuses.
- Limited literature exists on the specific risk factors and incidence of postoperative CVST after the retrosigmoid approach.
Purpose of the Study:
- To investigate the incidence and potential risk factors of postoperative cerebral venous sinus thrombosis (CVST) in patients undergoing the retrosigmoid approach.
- To differentiate between radiological CVST (rCVST) and clinically evident CVST (cCVST).
- To explore the relationship between surgical exposure of sigmoid and transverse sinuses and the development of rCVST and cCVST.
Main Methods:
- A retrospective analysis of 130 patients who underwent retrosigmoid surgery.
- Patients were categorized based on radiological evidence of CVST (rCVST) or clinical diagnosis during hospitalization (cCVST).
- Radiological CVST was identified by lack of contrast in sigmoid (SS) or transverse sinuses (TS). The closest distance from craniotomy to sinuses was measured to quantify sinus exposure. Statistical analysis was performed to assess correlations.
Main Results:
- The overall incidence of rCVST was 46.9%, predominantly in the transverse sinus (65.6%). Clinical CVST (cCVST) occurred in 3.1% of cases.
- No significant difference in sinus proximity was found for cCVST.
- Lower exposure of the transverse sinus correlated with a lower incidence of rCVST (p=0.009). Surgery on the side of the dominant sinus was associated with a higher frequency of rCVST (p=0.042).
Conclusions:
- Surgical approach on the side of the dominant sinus and the degree of sinus exposure appear to be associated with the development of radiological CVST.
- While clinical CVST was rare, radiological findings suggest a higher incidence of thrombosis in the transverse sinus.
- Further prospective studies are warranted to elucidate definitive risk factors and optimize management strategies for postoperative CVST.
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