Traumatic Cerebral Venous Sinus Thrombosis: Management and Outcomes

• Published in: World neurosurgery 2024-07, Vol.187, p.e949-e962
• Main Authors: Ma, Li, Nail, Tara Jayde, Hoz, Samer S., Puccio, Ava M., Lang, Michael J., Okonkwo, David O., Gross, Bradley A.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Brain Injuries, Traumatic - complications; Brain Injuries, Traumatic - diagnostic imaging; Brain Injuries, Traumatic - therapy; Brain injury; Female; Glasgow Outcome Scale; Head injuries; Humans; Intracranial; Male; Middle Aged; Prospective Studies; Registries; Retrospective Studies; Sinus thrombosis; Sinus Thrombosis, Intracranial - diagnostic imaging; Sinus Thrombosis, Intracranial - etiology; Skull Fractures - complications; Skull Fractures - diagnostic imaging; Traumatic; Treatment Outcome; Young Adult
• ISSN: 1878-8750; 1878-8769; 1878-8769
• DOI: 10.1016/j.wneu.2024.05.019

Traumatic brain injury (TBI) with skull fractures parallel to or crossing venous sinuses is a recognized risk factor for traumatic cerebral venous sinus thrombosis (tCVST). Despite the recognition of this traumatic pathology in the literature, no consensus regarding management has been achieved. This study aimed to evaluate the impact of tCVST on TBI outcomes and related complications. Patients within a prospective registry at a level I trauma center from 2014 to 2023 were reviewed to identify tCVST cases. The impact of tCVST presence on Glasgow Outcome Scale scores at 6 months, 30-day mortality, and hospital length of stay were evaluated in multivariable-adjusted analyses. Among 607 patients with TBI, 61 patients were identified with skull fractures extending to the vicinity of venous sinuses with dedicated venography. Twenty-eight of these 61 patients (44.3%) had tCVST. The majority (96.4%) of tCVST were located in a unilateral transverse or sigmoid sinus. Complete recanalization was observed in 28% of patients on follow-up imaging (7/25 with follow-up imaging). None of the 28 patients suffered attributable venous infarcts or thrombus propagation. In the adjusted analysis, there was no difference in the 30-day mortality or Glasgow Outcome Scale at 6 months between patients with and without tCVST. Unilateral tCVST follows a benign clinical course without associated increased mortality or morbidity. The management of tCVST should be distinct as compared to spontaneous CVST, likely without the need for anticoagulation.