Skip to main content
SpringerLink
Log in

Pediatric cerebral sinovenous thrombosis following cranial surgery

  • Original Paper
  • Published:
Child's Nervous System Aims and scope Submit manuscript

Abstract

Purpose

Pediatric cerebral sinovenous thrombosis (CSVT) is an important, though less common subtype of pediatric stroke. It has been linked to several risk factors, including cranial procedures, with few studies highlighting this relationship. The aim of this study was to characterize the diagnosis and treatment of CSVT after cranial surgery.

Methods

An institutional pediatric stroke research database was used to identify all CSVT cases diagnosed within 30 days of cranial surgery from November 2004 to December 2014. Thirteen subjects were retrospectively analyzed for clinical presentation, surgical details, radiographic characteristics, laboratory study results, treatment, and outcome. Diagnostic testing and treatment adhered to a consensus-based institutional stroke protocol.

Results

Cranial vault reconstruction, subdural empyema evacuation, and tumor resection were each observed in three subjects. Eleven (85%) subjects had sinus exposure during surgery, and eight (73%) developed thrombus in a sinus within or adjacent to the operative field. Two (15%) had documented iatrogenic sinus injury. On post-operative testing, ten (77%) subjects had prothrombotic abnormalities. Seven (54%) were treated with anti-coagulation therapy (ACT) starting on a median of post-operative day (POD) 3 (IQR 1–3) for a median of 2.9 months (IQR 2.4–5.4). Median time to imaging evidence of partial or complete recanalization was 2.4 months (IQR 0.7–5.1). No symptomatic hemorrhagic complications were encountered.

Conclusions

Pediatric CSVT may be encountered after cranial surgery, and decisions related to anti-coagulation are challenging. The risk of CSVT should be considered in pre-surgical planning and post-operative evaluation of cases with known risk factors. In our study, judicious use of ACT was safe in the post-operative period.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Ichord RN, Benedict SL, Chan AK, Kirkham FJ, Nowak-Gottl U, G. International Paediatric Stroke Study (2015) Paediatric cerebral sinovenous thrombosis: findings of the International Paediatric Stroke Study. Arch Dis Child 100(2):174–179

    Article  PubMed  Google Scholar 

  2. deVeber G, Andrew M, Adams C, Bjornson B, Booth F, Buckley DJ, Camfield CS, David M, Humphreys P, Langevin P, MacDonald EA, Gillett J, Meaney B, Shevell M, Sinclair DB, Yager J, Canadian Pediatric Ischemic Stroke Study Group (2001) Cerebral sinovenous thrombosis in children. N Engl J Med 345(6):417–423

    Article  CAS  PubMed  Google Scholar 

  3. Erdogan B, Caner H, Aydin MV, Yildirim T, Kahveci S, Sen O (2004) Hemispheric cerebrovascular venous thrombosis due to closed head injury. Childs Nerv Syst 20(4):239–242

    Article  PubMed  Google Scholar 

  4. Matsushige T, Nakaoka M, Kiya K, Takeda T, Kurisu K (2009) Cerebral sinovenous thrombosis after closed head injury. J Trauma 66(6):1599–1604

    Article  PubMed  Google Scholar 

  5. Xavier F, Komvilaisak P, Williams S, Kulkarni AV, deVeber G, Moharir MD (2014) Anticoagulant therapy in head injury-associated cerebral sinovenous thrombosis in children. Pediatr Blood Cancer 61(11):2037–2042

    Article  CAS  PubMed  Google Scholar 

  6. Sebire G, Tabarki B, Saunders DE, Leroy I, Liesner R, Saint-Martin C, Husson B, Williams AN, Wade A, Kirkham FJ (2005) Cerebral venous sinus thrombosis in children: risk factors, presentation, diagnosis and outcome. Brain 128(Pt 3):477–489

    Article  CAS  PubMed  Google Scholar 

  7. Vieira JP, Luis C, Monteiro JP, Temudo T, Campos MM, Quintas S, Nunes S (2010) Cerebral sinovenous thrombosis in children: clinical presentation and extension, localization and recanalization of thrombosis. Eur J Paediatr Neurol 14(1):80–85

    Article  CAS  PubMed  Google Scholar 

  8. Dlamini N, Billinghurst L, Kirkham FJ (2010) Cerebral venous sinus (sinovenous) thrombosis in children. Neurosurg Clin N Am 21(3):511–527

    Article  PubMed  PubMed Central  Google Scholar 

  9. Monagle P, Chan AK, Goldenberg NA, Ichord RN, Journeycake JM, Nowak-Gottl U, Vesely SK, P. American College of Chest (2012) Antithrombotic therapy in neonates and children: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 141(2 Suppl):e737S–e801S

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Roach ES, Golomb MR, Adams R, Biller J, Daniels S, Deveber G, Ferriero D, Jones BV, Kirkham FJ, Scott RM, Smith ER, American Heart Association Stroke Council, Council on Cardiovascular Disease in the Young (2008) Management of stroke in infants and children: a scientific statement from a Special Writing Group of the American Heart Association Stroke Council and the Council on Cardiovascular Disease in the Young. Stroke 39(9):2644–2691

    Article  PubMed  Google Scholar 

  11. Coutinho JM, Zuurbier SM, Gaartman AE, Dikstaal AA, Stam J, Middeldorp S, Cannegieter SC (2015) Association between anemia and cerebral venous thrombosis: case-control study. Stroke 46(10):2735–2740

    Article  CAS  PubMed  Google Scholar 

  12. Jensen AW, Tefferi A, Arndt CA (2007) Cerebral venous sinus thrombosis associated with essential thrombocytosis in a pediatric patient. J Pediatr Hematol Oncol 29(3):156–159

    Article  PubMed  Google Scholar 

  13. Bracken J, Barnacle A, Ditchfield M (2013) Potential pitfalls in imaging of paediatric cerebral sinovenous thrombosis. Pediatr Radiol 43(2):219–231

    Article  PubMed  Google Scholar 

  14. Leach JL, Fortuna RB, Jones BV, Gaskill-Shipley MF (2006) Imaging of cerebral venous thrombosis: current techniques, spectrum of findings, and diagnostic pitfalls. Radiographics 26(Suppl 1):S19–S41 discussion S42-3

    Article  PubMed  Google Scholar 

  15. Shroff M, deVeber G (2003) Sinovenous thrombosis in children. Neuroimaging Clin N Am 13(1):115–138

    Article  PubMed  Google Scholar 

  16. Athale U, Siciliano S, Thabane L, Pai N, Cox S, Lathia A, Khan A, Armstrong A, Chan AK (2008) Epidemiology and clinical risk factors predisposing to thromboembolism in children with cancer. Pediatr Blood Cancer 51(6):792–797

    Article  PubMed  Google Scholar 

  17. Tabori U, Beni-Adani L, Dvir R, Burstein Y, Feldman Z, Pessach I, Rechavi G, Constantini S, Toren A (2004) Risk of venous thromboembolism in pediatric patients with brain tumors. Pediatr Blood Cancer 43(6):633–636

    Article  PubMed  Google Scholar 

  18. Hung PL, Lin PC, Tseng PL (2013) Cerebral sinovenous thrombosis associated with mastoiditis due to recurrent otitis media. Am J Ther 20(6):e726–e728

    Article  PubMed  Google Scholar 

  19. Martinuzzo ME, Barrera LH, D’adamo MA, Otaso JC, Gimenez MI, Oyhamburu J (2014) Frequent false-positive results of lupus anticoagulant tests in plasmas of patients receiving the new oral anticoagulants and enoxaparin. Int J Lab Hematol 36(2):144–150

    Article  CAS  PubMed  Google Scholar 

  20. Moharir MD, Shroff M, Stephens D, Pontigon AM, Chan A, MacGregor D, Mikulis D, Adams M, deVeber G (2010) Anticoagulants in pediatric cerebral sinovenous thrombosis: a safety and outcome study. Ann Neurol 67(5):590–599

    CAS  PubMed  Google Scholar 

Download references

Acknowledgements

This study was supported by an American Pediatric Society and Society for Pediatric Research Award.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA

    Dmitriy Petrov, Zarina Ali & Shih-Shan Lang

  2. Temple University School of Medicine, Philadelphia, PA, USA

    Michael Y. Uohara

  3. Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA, 19104, USA

    Rebecca Ichord, Laura Jastrzab & Lori Billinghurst

  4. Division of Neurosurgery, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Shih-Shan Lang

Authors
  1. Dmitriy Petrov
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michael Y. Uohara
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rebecca Ichord
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Zarina Ali
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Laura Jastrzab
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Shih-Shan Lang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Lori Billinghurst
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lori Billinghurst.

Ethics declarations

This study was approved by the CHOP Institutional Review Board (IRB) and is in compliance with the 1964 Helsinki Declaration and its later amendments and ethical standards. Informed consent was obtained for all subjects included in this study.

Finacial Disclosure

The authors have no financial relationships relevant to this article to disclose.

Conflict of interest

The authors have no conflicts of interest to disclose.

Electronic supplementary material

ESM 1

(DOCX 56 kb)

ESM 2

(TIFF 345 kb)

ESM 3

(TIFF 70 kb)

ESM 4

(TIFF 72 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Petrov, D., Uohara, M.Y., Ichord, R. et al. Pediatric cerebral sinovenous thrombosis following cranial surgery. Childs Nerv Syst 33, 491–497 (2017). https://doi.org/10.1007/s00381-016-3329-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00381-016-3329-2

Keywords

Search

Navigation