gms | German Medical Science

Objective: Postoperative thromboembolic events occur frequently in patients harbouring intracranial pathologies. Especially, removal of Meningiomas or Gliomas is associated with hypercoagulability. The occurrence of sinus vein thrombosis (SVT) is a rare complication, with limited information on incidence, optimal treatment regimen and outcome.

Method: From January 2004 to December 2012 a total of 8054 procedures were analysed. Postoperative SVT was assessed radiologically. Patient and tumor characteristics (age, pathology, patient positioning, tumor localization), onset of postoperative neurological state, date of diagnosis of SVT, postoperative treatment and outcome were entered into a database.

Results: Postoperative SVT was diagnosed in 15 patients (m:w 1:2). Patients suffered from Meningioma in 7 cases, Glioblastoma in 1 case, while 7 patients had other histologic diagnosis. Risk factors for the onset of SVT or VTE were present in 4 patients. A traumatic lesion of a sinus was reported in 10 patients. 8 patients displayed a SVT in multiple sinuses. Diagnosis was obtained in routine postoperative imaging in 12 cases. Onset of SVT was significantly higher in patients suffering from a posterior fossa lesion (p<0,001) and patients positioned in a semi-sitting position (p<0,001). Half-therapeutic anticoagulation was initiated directly in patients with diagnosis on p.o. day 1 or 2. If diagnosed later on, full heparinization was initiated. Under anticoagulation, 2 patients developed hemorrhages and two patients developed ischemic strokes. Outcome was mRS <2 in 9 patients diagnosed SVT, two patients have died from complications.

Conclusions: These data supply detailed information about the incidence, risk factors and outcome of postoperative SVT after craniotomy for intracranial tumors. While our data support the rare incidence of postoperative SVT, patient positioning and localization of pathologies seems to play a role in the incidence of SVT. Although good outcome may be achieved with cautious use of anticoagulation in SVT treatment, potentially dangerous complications from SVT may occur.