General
- 32.4% (N=74 patients) had postoperative MR venograms confirming CVST, and all were asymptomatic.
- Clinically silent, with only a small number of patients becoming symptomatic.
- The presence and severity of symptoms depend on
- Extent of thrombosis
- Collateral venous drainage supply.
Risk factors
- Patient factors
- Dehydration
- Use of oral contraceptives,
- Presence of hematological: factor V Leiden.
- Surgical factors
- Intraoperative manipulation or retraction of the sinus, mechanical injury from drilling excessive bone wax use and propagation, or extended exposure to air contribute to CVST formation
- Tumour type
- Meningioma
- Adherent to sinus wall require more manipulation
- Parasagittal meningiomas which invade into the SSS
Symptoms
- Headache
- Most common
- N/V
- Altered mental status,
- Visual changes,
- Seizures,
- Pseudotumor cerebri
- Focal neurological deficit.
- Less common
- Death
- Due to haemorrhagic stroke
Investigation
- Radiological
- CTV
- More sensitive and can be performed to facilitate the diagnosis of CVST.
- Cons
- Radiation
- Confounding results due to artefact from the surrounding bone.
- MRI
- Non contrast MRV: 2D and 3D time-of-flight and phase-contrast MRV
- Contrast-enhanced MRV
- Cerebral angiography
- More invasive
- Gold standard
- Can be used to treat
Treatment
- For immediate postcraniotomy patients with CVST, systemic heparinization is a relative contraindication given the postoperative bleeding risk.
- Systemic heparinization
- Treatment of spontaneous CVST
- Carries a 40% risk of hemorrhage
- Treatment of immediate postcraniotomy CVST,
- A relative contraindication given the postoperative bleeding risk.
- Intravenous fluids was to prevent dehydration
- Thrombolytics being used as a salvage manoeuvre
Prognosis
- Has a relatively benign clinical course
- Patients can have good outcomes with conservative management while avoiding the increased risks associated with full-dose anticoagulation in the postoperative setting
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