Postoperative Cerebral Venous Sinus Thrombosis Following a Retrosigmoid Craniotomy-A Clinical and Radiological Analysis

Abstract

Postoperative cerebral venous sinus thrombosis (CVST) is a rare complication of the retrosigmoid approach. To address the lack of literature, we performed a retrospective analysis. The thromboses were divided into those demonstrating radiological (rCVST) and clinical (cCVST) features, the latter diagnosed during hospitalization. We identified the former by a lack of contrast in the sigmoid (SS) or transverse sinuses (TS), and evaluated the closest distance from the craniotomy to quantify sinus exposure. We included 130 patients (males: 52, females: 78) with a median age of 46.0. They had rCVST in 46.9% of cases, most often in the TS (65.6%), and cCVST in 3.1% of cases. Distances to the sinuses were not different regarding the presence of cCVST (p = 0.32 and p = 0.72). The distance to the SS was not different regarding rCVST (p = 0.13). However, lower exposure of the TS correlated with a lower incidence of rCVST (p = 0.009). When surgery was performed on the side of the dominant sinuses, rCVSTs were more frequent (p = 0.042). None of the other examined factors were related to rCVST or cCVST. Surgery on the side of the dominant sinus, and the exposing of them, seems to be related with rCVST. Further prospective studies are needed to identify the risk factors and determine the best management.

Keywords: cerebellopontine; craniotomy; dural; sinus; thrombosis; tumor.

Figure 1

Illustrative radiological axial (a,b) and coronal (c,d) contrast enhanced postoperative computed tomography scans with measurements. Sigmoid and transverse sinuses are exposed in (a,c), while unexposed in (b,d), respectively.

Figure 2

A receiver operating characteristic (ROC) curve analysis shows that exposing a transverse sinus by over 6.55 mm increases the risk of radiologic features of cerebral venous sinus thrombosis (rCVST). ROC curve is shown in blue color, reference line is shown in grey, an optimal cut-point according to the MaxSpSe method is shown in black dashed lines.