Postoperative venous sinus stenosis after retrosigmoid craniotomy: systematic review and illustrative case

Postoperative cerebral venous sinus complications in posterior fossa craniotomies are increasingly recognized but remain incompletely characterized. Although most cases are asymptomatic, impaired venous outflow may lead to intracranial hypertension. This work systematically reviews the available evidence on postoperative cerebral venous sinus complications following posterior fossa surgery, including its management; additionally, we present an illustrative case of postoperative venous sinus stenosis treated with endovascular venous sinus stenting.

We conducted a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses PRIMA guidelines using PubMed, Embase, and SCOPUS databases to identify and characterize cerebral venous sinus-related complications following posterior fossa surgery. Additionally, we present an illustrative case.

Thirty-three studies comprising 4,893 patients were included. CVST was reported in 429 of 4,237 patients (10.1%), whereas CVSS was identified in 135 of 784 patients (17.2%) from studies specifically evaluating stenosis. Intraoperative venous sinus injury occurred in 55 of 1,618 patients (3.4%). Only 16 patients underwent endovascular treatment, of whom 13 received venous sinus stenting. Our illustrative case involved a 28-year-old woman who developed intracranial hypertension secondary to severe postoperative transverse-sigmoid sinus stenosis following retrosigmoid vestibular schwannoma resection. Venous manometry demonstrated a significant trans-stenotic pressure gradient, and successful endovascular stenting restored venous outflow with sustained stent patency and clinical stability at 12-month follow-up.

Postoperative venous sinus complications following posterior fossa surgery are likely underrecognized, although clinically significant venous outflow obstruction remains uncommon. This systematic review highlights the limited evidence regarding postoperative venous sinus stenosis and its endovascular management. Venous sinus stenting may represent a promising treatment option in carefully selected patients with hemodynamically significant postoperative stenosis; however, larger prospective studies with standardized diagnostic criteria and long-term follow-up are needed to better define its role.