Sagittal sinus compression is associated with neonatal cerebral sinovenous thrombosis

Abstract

Objective: Neonatal cerebral sinovenous thrombosis (CSVT) causes lifelong morbidity. Newborns frequently incur positional occipital bone compression of the superior sagittal sinus (SSS). We hypothesized that SSS compression is associated with neonatal CSVT.

Methods: Our retrospective case-control study recruited neonates with CSVT (SickKids Children's Stroke Program, January 1992-December 2006). Controls were neonates without CSVT undergoing magnetic resonance or computed tomography venography (institutional imaging database, 2002-2005) who were matched 2 per each case patient. Blinded neuroimaging review by 2 experts quantified SSS compression and head position. Effect of SSS compression on the primary outcome of CSVT was determined (logistic regression). Secondary analyses included the relationship of head position to SSS compression (t test) and group comparisons (cases versus controls, cases with and without compression) for demographic, clinical, and CSVT factors (χ² and Wilcoxon Mann-Whitney tests).

Results: Case (n = 55) and control (n = 90) patients had similar ages and delivery modes. SSS compression was common (cases: 43%; controls: 41%). Controlling for gender and head position, SSS compression was associated with CSVT (odds ratio: 2.5 [95% confidence interval: 1.07-5.67]). Compression was associated with greater mean (SD) angle toward head flexion (101.2 [15.0] vs 111.5 [9.7]; P < .001). Among CSVT cases, neonates with and without compression had comparable gestational age, delivery mode, risk factors, anticoagulation treatment, thrombus location, propagation, infarction, recanalization, and outcome. Many idiopathic cases had SSS compression (79%). Interrater reliability of compression measurements was high (κ = 0.87).

Conclusions: Neonatal SSS compression is common, quantifiable, and associated with CSVT. Optimizing head position and/or developing devices to alleviate mechanical SSS compression may represent a novel means to improve outcomes.