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. 2024 Jun 6;5(1):540-551.
doi: 10.1089/neur.2023.0118. eCollection 2024.

Management of Traumatic Cerebral Venous Sinus Thrombosis: A United Kingdom and Ireland Survey on Practice Variation

Sheikh M B Momin  1   2 , David J Davies  1   3 , Philip J O'Halloran  1   4 , Antonio Belli  1   3 , Tonny Veenith  2   5 , Ramesh Chelvarajah  1   6 ; Birmingham Traumatic Venous Sinus Thrombosis Consortium**; Birmingham Traumatic Venous Sinus Thrombosis Consortium
Collaborators, Affiliations

Management of Traumatic Cerebral Venous Sinus Thrombosis: A United Kingdom and Ireland Survey on Practice Variation

Sheikh M B Momin et al. Neurotrauma Rep. .

Abstract

Traumatic cerebral venous sinus thrombosis (tCVST) is an increasingly recognized sequela of traumatic brain injury (TBI), with skull fractures and extradural hematomas overlying venous sinuses recognized as risk factors. Although it may be treated with anticoagulation, the decision to treat tCVST is nuanced by the risk of new or worsening hemorrhage. Presently, there are no guidelines on the investigation and management of tCVST. Therefore, we conducted a UK- and Ireland-wide practice variation survey. A 17-question survey was sent via Google Forms to neurosurgeons and intensive care doctors of at least ST3 (registrar) level and above in the UK and Ireland and distributed by the Society of British Neurological Surgeons and investigators of the Sugar or Salt trial between May 9, 2023, and September 15, 2023. Data were extracted from the survey for both qualitative and quantitative analyses. There were 41 respondents to the survey, 18 (43.9%) of whom were consultant neurosurgeons. Fifty-four percent of the respondents performed a computed tomography intracranial venogram to investigate for tCVST where there was a skull fracture overlying or adjacent to a venous sinus, whereas 43.9% performed these at the time of TBI diagnosis. Around three-fourth of the respondents anticoagulate for tCVST, largely within 3 days post-TBI. A range of hemorrhagic and thrombotic complications have been observed following decisions to treat and withhold treatment of tCVST, respectively. Around two-third of the respondents conducted follow-up imaging in confirmed tCVST. None of the respondents had an established departmental protocol for the management of tCVST. This UK- and Ireland-wide survey on the management of tCVST revealed a variation in its diagnosis, treatment, and follow-up with no departmental protocol established. The optimal diagnostic pathway, management protocol, and follow-up of patients with tCVST remain unknown and should be the subject of future studies.

Keywords: anticoagulation; survey; traumatic brain injury; venous sinus thrombosis.

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Figures

FIG. 1.
FIG. 1.
Geographical distribution of survey respondents.
FIG. 2.
FIG. 2.
Indications for CT intracranial venogram to investigate for suspected tCVST. CT, computed tomography; tCVST, traumatic cerebral venous sinus thrombosis.
FIG. 3.
FIG. 3.
Timing of CT intracranial venogram to investigate tCVST. CT, computed tomography; tCVST, traumatic cerebral venous sinus thrombosis.
FIG. 4.
FIG. 4.
Management practice for confirmed tCVST. tCVST, traumatic cerebral venous sinus thrombosis.
FIG. 5.
FIG. 5.
Anticoagulation dosing strategy for confirmed tCVST. tCVST, traumatic cerebral venous sinus thrombosis.
FIG. 6.
FIG. 6.
Timing of anticoagulation for confirmed tCVST. tCVST, traumatic cerebral venous sinus thrombosis.
FIG. 7.
FIG. 7.
Observed complications following anticoagulation administration for tCVST. tCVST, traumatic cerebral venous sinus thrombosis.
FIG. 8.
FIG. 8.
Reasons given for withholding anticoagulation in tCVST. tCVST, traumatic cerebral venous sinus thrombosis.
FIG. 9.
FIG. 9.
Observed complications following withholding anticoagulation in tCVST. tCVST, traumatic cerebral venous sinus thrombosis.
FIG. 10.
FIG. 10.
Timing of follow-up imaging in patients with confirmed tCVST. tCVST, traumatic cerebral venous sinus thrombosis.
See this image and copyright information in PMC

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