Skip to main content
SpringerLink
Log in

Dural sinus thrombosis after resection of vestibular schwannoma using suboccipital retrosigmoid approach—thrombosis classification and management proposal

  • Original Article
  • Published:
Neurosurgical Review Aims and scope Submit manuscript

Abstract

Dural sinus thrombosis is one of the complications after posterior fossa surgery. However, that topic is not described well with regard to vestibular schwannoma surgery using the unique suboccipital retrosigmoid approach. We analyzed retrospectively medical records and radiological investigations of 116 patients. The including criteria were histopathologically confirmed vestibular schwannoma operated on using the retrosigmoid approach, preoperative and postoperative contrast-enhanced MRI, and at least 1-year follow-up. The patient group included 36% males and 64% females. The average age was 47.3 ± 13.9 years. Sixty percent of the tumors were classified as T4b according to the Hannover scale and their mean volume was 13.73 ± 10.28 cm3. There were no signs of thrombosis preoperatively. Postoperative changes in the dural sinuses were found in 26 (22%) cases. In 7 (27%) cases, there was an external compression by the hemostatic agent, and in 19 (73%) cases, a thrombus was visualized in the sinus lumen. The size of the sinus, age, and the tumor size were not risk factors for thrombosis, whereas an intraoperative sinus injury was a statistically significant risk factor (p = 0.0012). All of the patients diagnosed with thrombosis were in good clinical condition in long-term follow-up, except one fatal case. Complete recanalization was observed in 58% of cases after 1-year follow-up. Postoperative changes in the dural venous sinuses are a frequent finding after vestibular schwannoma surgery using the suboccipital retrosigmoid approach. Intraoperative dural injury is a risk factor for thrombosis. Thrombosis in that group of patients is usually asymptomatic and does not influence the prognosis.

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

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

Availability of data and material

Available.

Code availability

Not applicable.

References

  1. Abou-Al-Shaar H, Gozal YM, Alzhrani G, Karsy M, Shelton C, Couldwell WT (2018) Cerebral venous sinus thrombosis after vestibular schwannoma surgery: a call for evidence-based management guidelines. Neurosurg Focus 45(1):E4. https://doi.org/10.3171/2018.4.FOCUS18112

    Article  PubMed  Google Scholar 

  2. Apra C, Kotbi O, Turc G et al (2017) Presentation and management of lateral sinus thrombosis following posterior fossa surgery. J Neurosurg 126(1):8–16. https://doi.org/10.3171/2015.11.JNS151881

    Article  PubMed  Google Scholar 

  3. Benjamin CG, Sen RD, Golfinos JG et al (2018) Postoperative cerebral venous sinus thrombosis in the setting of surgery adjacent to the major dural venous sinuses. J Neurosurg. https://doi.org/10.3171/2018.4.JNS18308

  4. Chibbaro S, Cebula H, Todeschi J et al (2018) Evolution of prophylaxis protocols for venous thromboembolism in neurosurgery: results from a prospective comparative study on low-molecular-weight heparin, elastic stockings, and intermittent pneumatic compression devices. World Neurosurg 109:e510–e516. https://doi.org/10.1016/j.wneu.2017.10.012

    Article  PubMed  Google Scholar 

  5. Guazzo E, Panizza B, Lomas A et al (2020) Cerebral venous sinus thrombosis after translabyrinthine vestibular schwannoma-a prospective study and suggested management paradigm. Otol Neurotol 41(2):e273–e279. https://doi.org/10.1097/MAO.0000000000002508

    Article  PubMed  Google Scholar 

  6. Keiper GL Jr, Sherman JD, Tomsick TA, Tew JM Jr (1999) Dural sinus thrombosis and pseudotumor cerebri: unexpected complications of suboccipital craniotomy and translabyrinthine craniectomy. J Neurosurg 91(2):192–197. https://doi.org/10.3171/jns.1999.91.2.0192

    Article  PubMed  Google Scholar 

  7. Kow CY, Caldwell J, Mchugh F, Sillars H, Bok A (2020) Dural venous sinus thrombosis after cerebellopontine angle surgery: should it be treated? J Clin Neurosci 75:157–162. https://doi.org/10.1016/j.jocn.2019.12.036

    Article  PubMed  Google Scholar 

  8. Moore J, Thomas P, Cousins V, Rosenfeld JV (2014) Diagnosis and management of dural sinus thrombosis following resection of cerebellopontine angle tumors. J Neurol Surg B Skull Base 75(6):402–408. https://doi.org/10.1055/s-0034-1376421

    Article  PubMed  PubMed Central  Google Scholar 

  9. Sawarkar DP, Verma SK, Singh PK, Doddamani R, Kumar A, Sharma BS (2016) Fatal superior sagittal sinus and torcular thrombosis after vestibular schwannoma surgery: report of a rare complication and review of the literature. World Neurosurg. 96:607.e19-607.e24. https://doi.org/10.1016/j.wneu.2016.09.075

    Article  Google Scholar 

  10. Shew M, Kavookjian H, Dahlstrom K et al (2018) Incidence and risk factors for sigmoid venous thrombosis following CPA tumor resection. Otol Neurotol 39(5):e376–e380. https://doi.org/10.1097/MAO.0000000000001806

    Article  PubMed  Google Scholar 

  11. Saposnik G, Barinagarrementeria F, Brown RD Jr et al (2011) Diagnosis and management of cerebral venous thrombosis: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 42(4):1158–1192

    Article  Google Scholar 

  12. Rahman M, Velat GJ, Hoh BL, Mocco J (2009) Direct thrombolysis for cerebral venous sinus thrombosis. Neurosurg Focus 27(5):E7

    Article  Google Scholar 

  13. Siddiqui FM, Dandapat S, Banerjee C et al (2015) Mechanical thrombectomy in cerebral venous thrombosis: systematic review of 185 cases. Stroke 46(5):1263–1268

    Article  Google Scholar 

Download references

Author information

Author notes

  1. Kamil Krystkiewicz

    Present address: Department of Neurosurgery and Neurooncology, Copernicus Memorial Hospital, Pabianicka 62, 95-513, Łódź, Poland

Authors and Affiliations

  1. Department of Neurosurgery and Neurooncology, Copernicus Memorial Hospital, Pabianicka 62, 95-513, Łódź, Poland

    Dawid Wrona & Marcin Tosik

  2. Department of Neurosurgery, 10th Military Research Hospital, Bydgoszcz, Poland

    Kamil Krystkiewicz, Marcin Birski, Anna Morawska, Jacek Furtak & Marek Harat

  3. Department of Clinical Pathomorphology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Torun, Poland

    Łukasz Szylberg

  4. Department of Tumor Pathology and Pathomorphology, Oncology Center, Prof. Franciszek Łukaszczyk Memorial Hospital, Bydgoszcz, Poland

    Łukasz Szylberg

  5. Department of Pathomorphology, 10th Military Clinical Hospital, Bydgoszcz, Poland

    Łukasz Szylberg

  6. Department of Radiology, 10th Military Clinical Hospital, Bydgoszcz, Poland

    Cezary Wałęsa & Konrad Stopa

  7. Department of Neurosurgery and Neurology, Collegium Medicum of the Nicolaus Copernicus University, Bydgoszcz, Poland

    Marek Harat

Authors
  1. Kamil Krystkiewicz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dawid Wrona
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marcin Tosik
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marcin Birski
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Łukasz Szylberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Anna Morawska
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jacek Furtak
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Cezary Wałęsa
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Konrad Stopa
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Marek Harat
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conceptualization—Kamil Krystkiewicz.

Methodology—Kamil Krystkiewicz.

Investigation—Kamil Krystkiewicz, Dawid Wrona, Marcin Tosik, Anna Morawska, Konrad Stopa, Cezary Wałęsa.

Formal analysis and investigation—Kamil Krystkiewicz, Marcin Birski, Łukasz Szylberg.

Writing (original draft preparation)—Kamil Krystkiewicz.

Writing (review and editing)—Marcin Birski, Marcin Tosik, Marek Harat.

Resources—Kamil Krystkiewicz, Jacek Furtak, Marcin Birski, Marek Harat.

Supervision—Marek Harat.

Corresponding author

Correspondence to Kamil Krystkiewicz.

Ethics declarations

Ethics approval

The Institutional Ethics Committee was informed about the ongoing study, and the Committee stated no need for its approval.

Consent to participate

Informed consent was obtained from all individual participants included in the study.

Consent for publication

Not applicable. No data, which could lead to the identification of the patient (photographs, names), was used.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Krystkiewicz, K., Wrona, D., Tosik, M. et al. Dural sinus thrombosis after resection of vestibular schwannoma using suboccipital retrosigmoid approach—thrombosis classification and management proposal. Neurosurg Rev 45, 2211–2219 (2022). https://doi.org/10.1007/s10143-022-01741-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10143-022-01741-3

Keywords

Search

Navigation