Pediatric cerebral sinovenous thrombosis following cranial surgery

Allbwn ymchwil: Cyfraniad at gyfnodolynErthygladolygiad gan gymheiriaid

Fersiynau electronig

Dangosydd eitem ddigidol (DOI)

  • Dmitriy Petrov
    Perelman School of Medicine of the University of Pennsylvania
  • Michael Y Uohara
    Temple University School of Medicine
  • Rebecca Ichord
    Children's Hospital of Philadelphia
  • Zarina Ali
    Perelman School of Medicine of the University of Pennsylvania
  • Laura Jastrzab
    Children's Hospital of Philadelphia
  • Shih-Shan Lang
    Perelman School of Medicine of the University of Pennsylvania
  • Lori Billinghurst
    Children's Hospital of Philadelphia

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.

Allweddeiriau

Iaith wreiddiolSaesneg
Tudalennau (o-i)491-497
Nifer y tudalennau7
CyfnodolynChild's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery
Cyfrol33
Rhif y cyfnodolyn3
Dynodwyr Gwrthrych Digidol (DOIs)
StatwsCyhoeddwyd - 14 Ion 2017
Cyhoeddwyd yn allanolIe
Gweld graff cysylltiadau