Traumatic Venous Sinus Thrombosis: Patient and Practice Patterns at a Major Trauma Center

Traumatic brain injury can lead to venous sinus injury and thrombosis, which may be associated with elevated intracranial pressure and poor outcomes. We sought to examine the risk factors, management, and clinical outcomes of traumatic venous sinus thrombosis (tVST).

We conducted a comprehensive search of our institutional radiology database for final radiology reports from 2013 to 2022 that contained the terms "venous sinus thrombosis," "sinus thrombosis," or "venous occlusion." tVST was detected on computed tomography and confirmed by a board-certified neuroradiologist.

We identified 135 patients on initial screening and entered 112 into our final analysis. Patients were predominantly male (76.8%) and had a mean age of 44 years. Initial Glasgow Coma Scale scores of 13-15, 9-12, and 3-8 were found in 60.7%, 12.5%, and 26.8% of our cohort, respectively. Eighty-nine patients (79.5%) were alive at hospital discharge. Most patients sustained skull fractures (n = 109, 97.3%), including skull base fractures. Seventeen patients required interventions for refractory intracranial hypertension, of whom 16 (94.1%) had multiple tVST. We observed heterogeneity in tVST monitoring and treatment practices. Patients received anticoagulation (AC; 13.4%), antiplatelet (AP; 34.8%), or conservative (no AC or AP; 51.8%) treatment for tVST. Follow-up imaging was available for 52 patients, showing recanalization of venous sinuses in 26 patients (50%) by 6 months post injury. Recanalization rates were higher in the AP group than in the AC group. However, this was likely the result of selection bias, in which patients with mild to moderate injuries were more likely to be assigned to AP therapy. We noted more bleeding complications in AC- and AP-treated patients (20.0% and 12.8%) than in conservatively managed patients (3.4%), even after adjusting for lower survival in the conservative group.

Differences between treatment groups should be cautiously interpreted due to selection bias and confounding by indication. More studies are needed to determine the optimal management of tVST.