Management and Outcomes in Traumatic Cerebral Venous Sinus Thrombosis

Traumatic cerebral venous sinus thrombosis (tCVST) is a rare complication of head trauma associated with increased mortality. Unlike in non-traumatic CVST, there are no consensus guidelines to direct the management of tCVST. Anticoagulation is often used to prevent intracranial complications; however, concurrent traumatic brain injury (TBI) and other injuries complicate treatment decisions, and its clinical benefit remains uncertain. This study describes the epidemiology, management, and clinical and radiographic outcomes of tCVST.

This is a retrospective single-center cohort study from a level 1 trauma center in Melbourne, Australia. Patients were identified from the Alfred Health Trauma Registry and hospital coding data between 1 January 2010 and 30 June 2024. Venous imaging was reviewed by two neuroradiologists to confirm tCVST diagnosis and thrombus characteristics. Primary outcomes were defined as discharge destination, with sinus recanalization on follow-up imaging as a secondary outcome.

tCVST was confirmed in 138 patients with an incidence of 0.9% in the TBI population and an all-cause inpatient mortality of 10.9% (15 patients). Anticoagulation was used in 78 patients (56.5%) and commenced a median of 5 days after diagnosis [interquartile range (IQR) 2-9]. Patients with anticoagulation generally had less severe traumatic injury, as measured by Injury Severity Score (ISS) and admission Glasgow Coma Scale (GCS), but were more likely to have occlusive thrombosis. Among 123 patients who survived to hospital discharge, 93 underwent follow-up venous imaging from day 14, with complete recanalization in 57% by final available imaging. Occlusive thrombosis and multiple sinus involvement were associated with poorer recanalization, while no association between anticoagulation and recanalization was identified.

Traumatic CVST is a rare complication of head injury with multiple confounders influencing outcomes and uncertain optimal management. Clinical benefit of anticoagulation in this cohort requires further investigation.