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Otogenic lateral sinus thrombosis in children: proposal of an experience-based treatment flowchart

  • Otology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

To describe the prevalent clinical, laboratory, and radiological features of otogenic lateral sinus thrombosis (OLST) in children; to identify clinical predictors of outcome; to propose a management algorithm derived from experience.

Methods

A retrospective review was conducted of the clinical records of patients with OLST, treated in a single tertiary care referral center for pediatric disease from 2006 to 2017. The inclusion criteria were pediatric age (0–16 years) and OLST diagnosis confirmed by a pre- and post-contrast CT or venography–MRI scan. Primary outcome measures were early (1–2 months) and late (6 months) sinus recanalization assessed by means of neuroimaging.

Results

Twenty-five patients (8 females and 17 males; mean age = 6 ± 3 years) were included. A genetic abnormality associated with thrombophilia was found in 24 (96%) patients. At diagnosis, anticoagulant treatment with low-molecular-weight heparin (LMWH) was started in all subjects, while surgical treatment (mastoidectomy and tympanostomy tube insertion) was performed in 16/25 (64%) patients. Follow-up neuroimaging showed lateral sinus recanalization in 12/25 (48%) patients after 1–2 months and in 17/25 (68%) after 6 months. At multivariate logistic regression analysis, no significant predictors of the early and late neuroradiological outcome were found.

Conclusions

All children with OLST should be screened for thrombophilia to decide on treatment duration and to assess the need for future antithrombotic prophylaxis. Immediately after diagnosis, anticoagulant treatment with LMWH should be started according to the international guidelines. Instead, our experience suggests that surgical treatment should not be indicated in all patients, but decided on a case-to-case basis.

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Authors and Affiliations

  1. Audiology and Otosurgery Unit, Department of Surgery, Cochlear Implant Referral Center, “Bambino Gesù” Pediatric Hospital, Piazza Sant’Onofrio, 4, 00165, Rome, Italy

    Alessandro Scorpecci, Sara Giannantonio, Daniela Lucidi, Silvia Foligno & Pasquale Marsella

  2. Oncohematology Department, Haemostasis and Thrombosis Center, Bambino Gesù Pediatric Hospital, Rome, Italy

    Michela Massoud, Paola Zangari & Matteo Luciani

  3. Audiology Section, Bio.Ne.C Department, University of Palermo, Palermo, Italy

    Francesco Martines

  4. Department of Laboratory, Bambino Gesù Pediatric Hospital, Rome, Italy

    Giovina Di Felice & Antonio Minozzi

Authors
  1. Alessandro Scorpecci
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  2. Michela Massoud
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  3. Sara Giannantonio
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  4. Paola Zangari
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  5. Daniela Lucidi
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  6. Francesco Martines
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  7. Silvia Foligno
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  8. Giovina Di Felice
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  9. Antonio Minozzi
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  10. Matteo Luciani
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  11. Pasquale Marsella
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Corresponding author

Correspondence to Alessandro Scorpecci.

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Scorpecci, A., Massoud, M., Giannantonio, S. et al. Otogenic lateral sinus thrombosis in children: proposal of an experience-based treatment flowchart. Eur Arch Otorhinolaryngol 275, 1971–1977 (2018). https://doi.org/10.1007/s00405-018-5033-1

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  • DOI: https://doi.org/10.1007/s00405-018-5033-1

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