Artikel
Postoperative cerebral venous sinus thrombosis following posterior fossa – tumor surgery – incidence, risk factors and therapeutic options
Postoperative Zerebrale Sinusvenenthrombose nach neurochirurgischen Eingriffen in der hinteren Schädelgrube: Inzidenz, Risikofaktoren und therapeutisches Management
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Veröffentlicht: | 25. Mai 2022 |
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Gliederung
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Objective: Cerebral venous sinus thrombosis (CVST) is a known complication of posterior fossa surgery near the sigmoid and transverse sinus. The incidence and treatment of postoperative asymptomatic CVST are controversial. This study aims to analyze the incidence, risk factors and the strategy of management of postoperative CVST after tumor surgery.
Methods: In this retrospective, single-center study, we included all patients who underwent tumor surgery in the posterior fossa in the sitting position between January 2013 and December 2020. We analyzed the effect of demographical and surgical data on the incidence of postoperative CVST. The two management options of postoperative CVST and the incidence of intracranial hemorrhage were analyzed.
Results: In total, 266 patients were identified and included. Thirty-three of 266 patients (12.4%) developed a postoperative CVST. 13 of the 33 patients received therapeutic anticoagulation, and 20 patients did not. Risk factors for the development of a postoperative CVST, were tumor entity: meningioma (p<0.001, OR 11.3, CI 95% 4.1-31.2), and vestibular schwannoma (p=0.013, OR 4.4, CI 95% 1.3-16.3). Age (p=0.562), sex (p=0.197), ASA status (p=0.125), BMI (p=0.591), and length of surgery (p=0.176) were not statistically correlated with new postoperative CVST. The use of therapeutic anticoagulation to treat postoperative CVST was associated with a higher rate of intracranial hemorrhage (n=4) in the univariate (p=0.017) as well as in the multivariate analysis (p<0.001, OR 47.1, 95% 6.6-334.18).
Conclusion: Tumor entity influences the incidence of new CVST. In clinically asymptomatic patients, careful decision-making is necessary whether to initiate therapeutic anticoagulation or not.