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Sinus Thrombosis

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Introduction to Vascular Neurosurgery

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Abstract

Cerebral venous sinus thrombosis is a rare cause of stroke with a variable clinical presentation and potentially fatal outcomes secondary to venous hypertension. Headache is the most common presenting symptom and a high index of clinical suspicion is required to ensure timely diagnosis via computed tomograpy venogram (CTV)/MRV. Anticoagulation with LMWH or UFH is recommended in the acute phase even in the presence of intracerebral hemorrhage in order to prevent thrombus progression, promote recanalization, and decrease venous congestion. Transition to oral anticoagulation is recommended with the duration of treatment dependent on risk factors, clinical history, and underlying etiology of CVT in order to prevent progressive and recurrent thromboembolic events. Sequela associated with CVT such as seizures and intracranial hypertension needs to be treated in order to prevent further neurological injury. For patients with persistent neurological decline or failure of systemic anticoagulation therapy, endovascular techniques such as catheter-directed thrombolysis and mechanical thrombectomy have emerged as successful treatment options. Patients with significant associated mass effect may require life-saving decompressive craniectomy. Despite these treatment options, CVT may result in significant morbidity and mortality. As a result, there remains significant room for continued studies to further define optimal management strategies for CVT.

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References

  1. Saposnik G, Barinagarrementeria F, Brown RD, Bushnell CD, Cucchiara B, Cushman M, et al. Diagnosis and management of cerebral venous thrombosis: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011;42(4):1158–92.

    Article  PubMed  Google Scholar 

  2. Renowden S. Cerebral venous sinus thrombosis. Eur Radiol. 2004;14(2):215–26.

    Article  PubMed  Google Scholar 

  3. Silvis SM, de Sousa DA, Ferro JM, Coutinho JM. Cerebral venous thrombosis. Nat Rev. 2017;13(9):555–65.

    Google Scholar 

  4. Ribes F. Exposé succinct des recherches faites sur la phlébite. Gueffier; 1825.

    Google Scholar 

  5. Abercrombie J. ART. XV. Pathological and practical researches on the diseases of the brain and the spinal cord. Am J Med Sci. 1828;4:384–9.

    Article  Google Scholar 

  6. Ferro JM, Canhão P, Stam J, Bousser MG, Barinagarrementeria F. Prognosis of cerebral vein and dural sinus thrombosis: results of the international study on cerebral vein and dural sinus thrombosis (ISCVT). Stroke. 2004;35(3):664–70.

    Article  PubMed  Google Scholar 

  7. Goldberg AL, Rosenbaum AE, Wang H, Kim WS, Lewis VL, Hanley DF. Computed tomography of dural sinus thrombosis. J Comput Assist Tomogr. 1986;10(1):16–20.

    Article  CAS  PubMed  Google Scholar 

  8. Mattle HP, Wentz KU, Edelman RR, Wallner B, Finn JP, Barnes P, et al. Cerebral venography with MR. Radiology. 1991;178(2):453–8.

    Article  CAS  PubMed  Google Scholar 

  9. Krayenbuhl HA. Cerebral venous and sinus thrombosis. Neurol Med Chir (Tokyo). 1968;10:1–24.

    Article  CAS  Google Scholar 

  10. Stam J. Thrombosis of the cerebral veins and sinuses. N Engl J Med. 2005;352(17):1791–8.

    Article  CAS  PubMed  Google Scholar 

  11. Li L-F, Pu JK-S, Tsang C-P, Tsang AC-O, Lui W-M, Leung GK-K. Iatrogenic sigmoid sinus occlusion rescued by graft repair and endovascular thrombolysis. World Neurosurg. 2017;104:1047.e13–7.

    Article  Google Scholar 

  12. Honig A, Eliahou R, Pikkel YY, Leker RR. Iatrogenic intracranial hypotension and cerebral venous thrombosis. J Neurol Sci. 2016;366:191–4.

    Article  PubMed  Google Scholar 

  13. Barboza MA, Chiquete E, Arauz A, Merlos-Benitez M, Quiroz-Compeán A, Barinagarrementería F, et al. A practical score for prediction of outcome after cerebral venous thrombosis. Front Neurol. 2018;9(Oct):882.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Ferro JM, Bacelar-Nicolau H, Rodrigues T, Bacelar-Nicolau L, Canhão P, Crassard I, et al. Risk score to predict the outcome of patients with cerebral vein and dural sinus thrombosis. Cerebrovasc Dis. 2009;28(1):39–44.

    Article  PubMed  Google Scholar 

  15. De Bruijn SFTM, Stam J, Kappelle LJ. Thunderclap headache as first symptom of cerebral venous sinus thrombosis. Lancet. 1996;348(9042):1623–5.

    Article  PubMed  Google Scholar 

  16. Leker RR, Steiner I. Features of dural sinus thrombosis simulating pseudotumor cerebri. Eur J Neurol. 1999;6(5):601–4.

    Article  CAS  PubMed  Google Scholar 

  17. Tehindrazanarivelo A, Evrard S, Schaison M, Mas J-L, Dormont D, Bousser M-G. Prospective study of cerebral sinus venous thrombosis in patients presenting with benign intracranial hypertension. Cerebrovasc Dis. 1992;2(1):22–7.

    Article  Google Scholar 

  18. Ameri A, Bousser M-G. Cerebral venous thrombosis. Neurol Clin. 1992;10(1):87–111.

    Article  CAS  PubMed  Google Scholar 

  19. Ferro JM, Correia M, Rosas MJ, Pinto AN, Neves G. Seizures in cerebral vein and dural sinus thrombosis. Cerebrovasc Dis. 2003;15(1–2):78–83.

    Article  CAS  PubMed  Google Scholar 

  20. Schaller B, Graf R. Cerebral venous infarction: the pathophysiological concept. Cerebrovasc Dis. Karger Publishers. 2004;18:179–88.

    Article  CAS  PubMed  Google Scholar 

  21. Fujita K, Kojima N, Tamaki N, Matsumoto S. Brain edema in intracranial venous hypertension. In: Brain edema. Berlin Heidelberg: Springer; 1985. p. 228–34.

    Chapter  Google Scholar 

  22. Bering EA, Salibi B. Production of hydrocephalus by increased cephalic-venous pressure. Arch Neurol Psychiatr. 1959;81(6):693–8.

    Article  Google Scholar 

  23. Ferro JM, Canhão P, Stam J, Bousser M-G, Barinagarrementeria F, Massaro A, et al. Delay in the diagnosis of cerebral vein and dural sinus thrombosis: influence on outcome. Stroke. 2009;40(9):3133–8.

    Article  PubMed  Google Scholar 

  24. Bonneville F. Imaging of cerebral venous thrombosis. Diagn Interv Imaging. Elsevier Masson SAS. 2014;95:1145–50.

    Article  CAS  PubMed  Google Scholar 

  25. Dormont D, Anxionnat R, Evrard S, Louaille C, Chiras J, Marsault C. MRI in cerebral venous thrombosis. J Neuroradiol. 1994;21(2):81–99.

    CAS  PubMed  Google Scholar 

  26. Masuhr F, Busch M, Amberger N, Ortwein H, Weih M, Neumann K, et al. Risk and predictors of early epileptic seizures in acute cerebral venous and sinus thrombosis. Eur J Neurol. 2006;13(8):852–6.

    Article  CAS  PubMed  Google Scholar 

  27. José MF, Patrícia C, Marie-Germaine B, Jan S, Fernando B. Early seizures in cerebral vein and dural sinus thrombosis. Stroke. 2008;39(4):1152–8.

    Article  Google Scholar 

  28. Ferro JM, Bousser MG, Canhão P, Coutinho JM, Crassard I, Dentali F, et al. European Stroke Organization guideline for the diagnosis and treatment of cerebral venous thrombosis – endorsed by the European Academy of Neurology. Eur J Neurol. 2017;24(10):1203–13.

    Article  CAS  PubMed  Google Scholar 

  29. Wasay M, Bakshi R, Bobustuc G, Kojan S, Sheikh Z, Dai A, et al. Cerebral venous thrombosis: analysis of a multicenter cohort from the United States. J Stroke Cerebrovasc Dis. 2008;17(2):49–54.

    Article  PubMed  Google Scholar 

  30. Wu YW, Hamrick SEG, Miller SP, Haward MF, Lai MC, Callen PW, et al. Intraventricular hemorrhage in term neonates caused by sinovenous thrombosis. Ann Neurol. 2003;54(1):123–6.

    Article  PubMed  Google Scholar 

  31. Karina JK, de Vries Linda S, van Straaten H, (Irma) LM, Benders Manon JNL, Rutger AJN, Floris G. Anticoagulation Therapy and Imaging in Neonates With a Unilateral Thalamic Hemorrhage Due to Cerebral Sinovenous Thrombosis. Stroke 2009;40(8):2754–60.

    Google Scholar 

  32. Murdock J, Tzu JH, Schatz NJ, Lee WW. Optic nerve sheath fenestration for the treatment of papilledema secondary to cerebral venous thrombosis. J Neuroophthalmol. 2014;34(1):67–9.

    Article  PubMed  Google Scholar 

  33. Lobo S, Ferro JM, Barinagarrementeria F, Bousser MG, Canhão P, Stam J. Shunting in acute cerebral venous thrombosis: a systematic review. Cerebrovasc Dis. 2014;37(1):38–42.

    Article  CAS  PubMed  Google Scholar 

  34. Constantine CP, Van VH, Christopher FD, Todd EL, Adel MM, Philip MM, et al. Acquired pial arteriovenous fistula following cerebral vein thrombosis. Stroke. 1999;30(11):2487–90.

    Article  Google Scholar 

  35. Sun L-L, Tang W-X, Liu L, Wang W, Zhang S-X, Liu Z-J. Dural arteriovenous fistula disguised as cerebral venous sinus thrombosis. J Zhejiang Univ. 2017;18(8):733–6.

    Article  Google Scholar 

  36. de Sousa DA, Lucas NL, Patrícia C, José MF. Recanalization in cerebral venous thrombosis. Stroke. 2018;49(8):1828–35.

    Article  Google Scholar 

  37. Einhäupl KM, Villringer A, Mehraein S, Garner C, Pellkofer M, Haberl RL, et al. Heparin treatment in sinus venous thrombosis. Lancet. 1991;338(8767):597–600.

    Article  PubMed  Google Scholar 

  38. De Bruijn SFTM, Stam J. Randomized, placebo-controlled trial of anticoagulant treatment with low-molecular-weight heparin for cerebral sinus thrombosis. Stroke. 1999;30(3):484–8.

    Article  PubMed  Google Scholar 

  39. Coutinho J, de Bruijn S, de Veber G, Stam J. Anticoagulation for cerebral venous sinus thrombosis. Cochrane Database Syst Rev. 2011;(8):CD002005.

    Google Scholar 

  40. de Sousa DA, Ferro JM, Canhão P, Barinagarrementeria F, Bousser M-G, Stam J, et al. Cerebral venous thrombosis causing posterior fossa lesions: description of a case series and assessment of safety of anticoagulation. Cerebrovasc Dis. 2014;38(5):384–8.

    Article  Google Scholar 

  41. Marie G, José MF, Patrícia C, Jan S, Marie-Germaine B, Fernando B, et al. Predictors of outcome in patients with cerebral venous thrombosis and intracerebral hemorrhage. Stroke. 2007;38(2):337–42.

    Article  Google Scholar 

  42. Jonathan MC, José MF, Patrícia C, Fernando B, Marie-Germaine B, Jan S. Unfractionated or low–molecular weight heparin for the treatment of cerebral venous thrombosis. Stroke. 2010;41(11):2575–80.

    Article  Google Scholar 

  43. van Dongen CJ, van den Belt AG, Prins MH, Lensing A. Fixed dose subcutaneous low molecular weight heparins versus adjusted dose unfractionated heparin for venous thromboembolism. Cochrane Database Syst Rev. John Wiley & Sons, Ltd. 2004;(9):CD001100.

    Google Scholar 

  44. Misra UK, Kalita J, Chandra S, Kumar B, Bansal V. Low molecular weight heparin versus unfractionated heparin in cerebral venous sinus thrombosis: a randomized controlled trial. Eur J Neurol. 2012;19(7):1030–6.

    Article  CAS  PubMed  Google Scholar 

  45. Idiculla PS, Gurala D, Palanisamy M, Vijayakumar R, Dhandapani S, Nagarajan E. Cerebral venous thrombosis: a comprehensive review. Eur Neurol. 2020;83:1–11.

    Google Scholar 

  46. Miranda B, Ferro JM, Canhão P, Stam J, Bousser MG, Barinagarrementeria F, et al. Venous thromboembolic events after cerebral vein thrombosis. Stroke. 2010;41(9):1901–6.

    Article  PubMed  Google Scholar 

  47. Christina G, Daniel R, Christian H, Peter AR, Simon N. Novel factor xa inhibitor for the treatment of cerebral venous and sinus thrombosis. Stroke. 2014;45(8):2469–71.

    Article  Google Scholar 

  48. Mendonça MD, Barbosa R, Cruz-e-Silva V, Calado S, Viana-Baptista M. Oral direct thrombin inhibitor as an alternative in the management of cerebral venous thrombosis: a series of 15 patients. Int J Stroke. 2015;10(7):1115–8.

    Article  PubMed  Google Scholar 

  49. Coutinho JM, Zuurbier SM, Bousser MG, Ji X, Canhao P, Roos YB, et al. Effect of endovascular treatment with medical management vs standard care on severe cerebral venous thrombosis: the TO-ACT randomized clinical trial. JAMA Neurol. 2020;77(8):966–73.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Siddiqui FM, Banerjee C, Zuurbier SM, Hao Q, Ahn C, Pride GL, et al. Mechanical thrombectomy versus intrasinus thrombolysis for cerebral venous sinus thrombosis: a non-randomized comparison. Interv Neuroradiol. 2014;20(3):336–44.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Lee S-K, Mokin M, Hetts SW, Fifi JT, Bousser M-G, Fraser JF. Current endovascular strategies for cerebral venous thrombosis: report of the SNIS Standards and Guidelines Committee. J NeuroIntervent Surg. 2018;10(8):803.

    Article  Google Scholar 

  52. Mokin M, Lopes DK, Binning MJ, Veznedaroglu E, Liebman KM, Arthur AS, et al. Endovascular treatment of cerebral venous thrombosis: contemporary multicenter experience. Interv Neuroradiol. 2015;21(4):520–6.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Canhão P, Falcão F, Ferro JM. Thrombolytics for cerebral sinus thrombosis. Cerebrovasc Dis. 2003;15(3):159–66.

    Article  PubMed  Google Scholar 

  54. Jankowitz BT, Bodily LM, Jumaa M, Syed ZF, Jovin TG. Manual aspiration thrombectomy for cerebral venous sinus thrombosis. J NeuroIntervent Surg. 2013;5(6):534.

    Article  Google Scholar 

  55. Gariel F, Berge J, Dousset V. Neurological recovery after coma related to diffuse cerebral venous sinus thrombosis. Interest in thrombi-aspiration with Penumbra system. Interv Neuroradiol. 2015;21(2):218–21.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Dashti SR, Hu YC, Yao T, Fiorella D, Mitha AP, Albuquerque FC, et al. Mechanical thrombectomy as first-line treatment for venous sinus thrombosis: technical considerations and preliminary results using the AngioJet device. J NeuroIntervent Surg. 2013;5(1):49.

    Article  Google Scholar 

  57. Taniguchi S, Harada K, Kajihara M, Fukuyama K. Combined use of stent-retriever and aspiration thrombectomy for cerebral venous sinus thrombosis involving the straight sinus: a case report. Interv Neuroradiol. 2017;23(6):605–8.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Mascitelli JR, Pain M, Zarzour HK, Baxter P, Ghatan S, Mocco J. Republished: sinus thrombectomy for purulent cerebral venous sinus thrombosis utilizing a novel combination of the Trevo stent retriever and the Penumbra ACE aspiration catheter: the stent anchor with mobile aspiration technique. J NeuroIntervent Surg. 2016;8(6):e24.

    Article  Google Scholar 

  59. Froehler MT. Successful treatment of cerebral venous sinus thrombosis with the Solitaire FR thrombectomy device. J NeuroIntervent Surg. 2013;5(6):e45.

    Article  Google Scholar 

  60. Chen C, Wang Q, Li X, Lu Z, He J, Fang Q, et al. Stent retriever thrombectomy combined with local thrombolytic therapy for cerebral venous sinus thrombosis: a case report Corrigendum in /10.3892/etm.2017.5676. Exp Ther Med. 2017;14(5):3961–70.

    PubMed  PubMed Central  Google Scholar 

  61. Matsuda Y, Okada H, Chung J, Crowley RW, Lopes DK. Novel balloon-and-aspiration method for cerebral venous sinus thrombosis: dental-floss technique. Neurosurg Focus FOC. 2017;42(4):E19.

    Article  Google Scholar 

  62. Adachi H, Mineharu Y, Ishikawa T, Imamura H, Yamamoto S, Todo K, et al. Stenting for acute cerebral venous sinus thrombosis in the superior sagittal sinus. Interv Neuroradiol. 2015;21(6):719–23.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Yeo LLL, Lye PPS, Yee KW, Cunli Y, Ming TT, Ho AFW, et al. Deep cerebral venous thrombosis treatment. Clin Neuroradiol. 2020;30(4):661–70.

    Article  PubMed  Google Scholar 

  64. Persson L, Lilja A. Extensive dural sinus thrombosis treated by surgical removal and local streptokinase infusion. Neurosurgery. 1990;26(1):117–21.

    Article  CAS  PubMed  Google Scholar 

  65. Ekseth K, Boström S, Vegfors M. Reversibility of severe sagittal sinus thrombosis with open surgical thrombectomy combined with local infusion of tissue plasminogen activator: technical case report. Neurosurgery. 1998;43(4):960–4.

    Article  CAS  PubMed  Google Scholar 

  66. Lechanoine F, Janot K, Herbreteau D, Maldonado IL, Velut S. Surgical thrombectomy combined with bilateral decompressive craniectomy in a life-threatening case of coma from cerebral venous sinus thrombosis: case report and literature review. World Neurosurg. 2018;120:485–9.

    Article  PubMed  Google Scholar 

  67. Patrícia C, José MF, Arne GL, Marie-Germaine B, Jan S, Fernando B. Causes and predictors of death in cerebral venous thrombosis. Stroke. 2005;36(8):1720–5.

    Article  Google Scholar 

  68. José MF, Isabelle C, Jonathan MC, Patrícia C, Fernando B, Brett C, et al. Decompressive surgery in cerebrovenous thrombosis. Stroke. 2011;42(10):2825–31.

    Article  Google Scholar 

  69. Aaron S, Alexander M, Moorthy RK, Mani S, Mathew V, Patil AKB, et al. Decompressive craniectomy in cerebral venous thrombosis: a single centre experience. J Neurol Neurosurg Psychiatry. 2013;84(9):995.

    Article  PubMed  Google Scholar 

  70. Zuurbier SM, Coutinho JM, Majoie CBLM, Coert BA, van den Munckhof P, Stam J. Decompressive hemicraniectomy in severe cerebral venous thrombosis: a prospective case series. J Neurol. 2012;259(6):1099–105.

    Article  PubMed  Google Scholar 

  71. Keller E, Pangalu A, Fandino J, Könü D, Yonekawa Y. Decompressive craniectomy in severe cerebral venous and dural sinus thrombosis. In: Yonekawa Y, Keller E, Sakurai Y, Tsukahara T, editors. New trends of surgery for stroke and its perioperative. Vienna: Springer Vienna; 2005. p. 177–83.

    Chapter  Google Scholar 

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  1. Department of Neurosurgery, Temple University Hospital, Philadelphia, PA, USA

    Eric Quach, Anand Kaul & Rami O. Almefty

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  1. Eric Quach
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Correspondence to Rami O. Almefty .

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  1. Department of Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA

    Justin R. Mascitelli

  2. Global Neurosciences Institute, Drexel University, Pennington, NJ, USA

    Mandy J. Binning

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Quach, E., Kaul, A., Almefty, R.O. (2022). Sinus Thrombosis. In: Mascitelli, J.R., Binning, M.J. (eds) Introduction to Vascular Neurosurgery. Springer, Cham. https://doi.org/10.1007/978-3-030-88196-2_18

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