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The role of anticoagulation for superior sagittal sinus thrombosis following craniotomy for resection of parasagittal/parafalcine meningiomas

  • Clinical Study
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Abstract

Objective

The safety and efficacy of anticoagulation in managing superior sagittal sinus (SSS) thrombosis remains unclear. The present study investigated the relationship between anticoagulation and cerebrovascular complications in parasagittal/parafalcine meningioma patients presenting with post-surgical SSS thrombosis.

Methods

We analyzed 266 patients treated at a single institution between 2005 and 2020. Bivariate analysis was conducted using the Mann–Whitney U test and Fisher’s exact test. Multivariate analysis was conducted using a logistic regression model. Blood thinning medications investigated included aspirin, warfarin, heparin, apixaban, rivaroxaban, and other novel oral anticoagulants (NOACs). A symptomatic SSS thrombosis was defined as a radiographically apparent thrombosis with new headaches, seizures, altered sensorium, or neurological deficits.

Results

Our patient cohort was majority female (67.3%) with a mean age (\(\pm\) SD) of 58.82 \(\pm\) 13.04 years. A total of 15 (5.6%) patients developed postoperative SSS thrombosis and 5 (1.9%) were symptomatic; 2 (0.8%) symptomatic patients received anticoagulation. None of these 15 patients developed cerebrovascular complications following observation or anticoagulative treatment of asymptomatic SSS thrombosis. While incidence of any other postoperative complications was significantly associated with SSS thrombosis in bivariate analysis (p = 0.015), this association was no longer observed in multivariate analysis (OR = 2.15, p = 0.16) when controlling for patient age, sex, and anatomical location of the tumor along the SSS.

Conclusions

Our single-institution study examining the incidence of SSS thrombosis and associated risk factors highlights the need for further research efforts better prognosticate this adverse outcome. Conservative management may represent a viable treatment strategy for patients with SSS thrombosis.

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The authors have full control of all primary data and agree to allow the journal to review their data if requested.

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Acknowledgements

We thank Robert M. Romano for his editorial support in the preparation of this manuscript

Funding

The authors received no funding for the research, authorship, and/or publication of this article. The authors acknowledge assistance for clinical data coordination and retrieval from the Core for Clinical Research Data Acquisition, supported in part by the Johns Hopkins) Institute for Clinical and Translational Research (UL1TR001079).

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Author notes

  1. Adrian E. Jimenez and Adham M. Khalafallah both contributed equally to this study

Authors and Affiliations

  1. Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD, 21287, USA

    Adrian E. Jimenez, David Botros, Melanie A. Horowitz, Omar Azmeh, Leonardo A. P. Oliveira, Sachiv Chakravarti, Sophie Liu, Esther Wu, Oren Wei, Jose L. Porras, Chetan Bettegowda, Rafael J. Tamargo, Henry Brem & Debraj Mukherjee

  2. Department of Neurological Surgery, University of Miami School of Medicine, Miami, FL, 33136, USA

    Adham M. Khalafallah

  3. Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, 37232, USA

    Shravika Lam

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  1. Adrian E. Jimenez
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Contributions

AJ, AK, and DM contributed to the study conception and design. Material preparation, data collection and analysis were performed by AJ, AM, DB, MH, OA, SL, LO, SC, SL, EW, and OW. The first draft of the manuscript was written by AJ and AM, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Debraj Mukherjee.

Ethics declarations

Conflict of interest

AJ declares that he has no conflict of interest. AM declares that he has no conflict of interest. DB declares that she has no conflict of interest. MH declares that she has no conflict of interest. OA declares that he has no conflict of interest. Shravika Lam declares that she has no conflict of interest. LO declares that he has no conflict of interest. SC declares that he has no conflict of interest. Sophie Liu declares that he has no conflict of interest. EW declares that she has no conflict of interest. OW declares that he has no conflict of interest. JP declares that he has no conflict of interest. CB is a consultant for Depuy-Synthes and Bionaut Labs. RT declares that he has no conflict of interest. HB is a consultant for AsclepiX Therapeutics, StemGen, InSightec, Accelerating Combination Therapies, NexImmune, Camden Partners, LikeMinds Inc., Galen Robotics Inc., and Nurami Medical, and he receives support from Arbor Pharmaceuticals, Bristol-Myers Squibb, and AcuityBio Corp. for non–study-related clinical or research effort. DB declares that he has no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

The Institutional Review Board (IRB), acting as a Health Insurance Portability and Accountability Act (HIPAA) Privacy Board, reviewed and approved the waiver of informed consent for this retrospective study (IRB00181593).

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Jimenez, A.E., Khalafallah, A.M., Botros, D. et al. The role of anticoagulation for superior sagittal sinus thrombosis following craniotomy for resection of parasagittal/parafalcine meningiomas. J Neurooncol 156, 341–352 (2022). https://doi.org/10.1007/s11060-021-03916-2

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  • DOI: https://doi.org/10.1007/s11060-021-03916-2

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