Presentation and Management of Cerebral Venous Sinus Thrombosis After Supratentorial Craniotomy

Martin Planet; Alexandre Roux; Angela Elia; Alessandro Moiraghi; Arthur Leclerc; Oumaima Aboubakr; Aziz Bedioui; Giorgia Antonia Simboli; Joseph Benzakoun; Eduardo Parraga; Edouard Dezamis; Jun Muto; Fabrice Chrétien; Catherine Oppenheim; Guillaume Turc; Marc Zanello; Johan Pallud

doi:10.1227/neu.0000000000002825

Presentation and Management of Cerebral Venous Sinus Thrombosis After Supratentorial Craniotomy

Neurosurgery. 2024 Jan 11. doi: 10.1227/neu.0000000000002825. Online ahead of print.

Authors

Martin Planet¹, Alexandre Roux^{1

2}, Angela Elia^{1

2}, Alessandro Moiraghi^{1

2}, Arthur Leclerc^{1

2

3

4}, Oumaima Aboubakr¹, Aziz Bedioui¹, Giorgia Antonia Simboli^{1

2}, Joseph Benzakoun^{2

5}, Eduardo Parraga¹, Edouard Dezamis¹, Jun Muto⁶, Fabrice Chrétien^{2

7}, Catherine Oppenheim^{2

5}, Guillaume Turc^{2

8

9}, Marc Zanello^{1

2}, Johan Pallud^{1

2}

Affiliations

¹ Department of Neurosurgery, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France.
² Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Paris, France.
³ Department of Neurosurgery, Caen University Hospital, Caen, France.
⁴ Normandy University, Unicaen, ISTCT/CERVOxy Group, UMR6030, GIP CYCERON, Caen, France.
⁵ Department of Neuroradiology, GHU Paris Psychiatrie et Neurosciences, Site Sainte Anne, Paris, France.
⁶ Department of Neurosurgery, Fujita Health University, Aichi, Japan.
⁷ Department of Neuropathology, GHU Paris Psychiatrie et Neurosciences, Site Sainte Anne, Paris, France.
⁸ Department of Neurology, GHU Paris Psychiatrie et Neurosciences, Site Sainte Anne, Paris, France.
⁹ FHU Neurovasc, Paris, France.

PMID: 38206001
DOI: 10.1227/neu.0000000000002825

Abstract

Background and objectives: Cerebral venous sinus thrombosis (CVST) after supratentorial craniotomy is a poorly studied complication, for which there are no management guidelines. This study assessed the incidence, associated risk factors, and management of postoperative CVST after awake craniotomy.

Methods: This is an observational, retrospective, monocentric analysis of patients who underwent a supratentorial awake craniotomy. Postoperative CVST was defined as a flow defect on the postoperative contrast-enhanced 3D T1-weighted sequence and/or as a T2* hypointensity within the sinus.

Results: In 401 supratentorial awake craniotomies (87.3% of diffuse glioma), the incidence of postoperative CVST was 4.0% (95% CI 2.5-6.4): 14/16 thromboses located in the superior sagittal sinus and 12/16 located in the transverse sinus. A venous sinus was exposed during craniotomy in 45.4% of cases, and no intraoperative injury to a cerebral venous sinus was reported. All thromboses were asymptomatic, and only two cases were diagnosed at the time of the first postoperative imaging (0.5%). Postoperative complications, early postoperative Karnofsky Performance Status score, and duration of hospital stay did not significantly differ between patients with and without postoperative CVST. Adjusted independent risk factors of postoperative CVST were female sex (adjusted Odds Ratio 4.00, 95% CI 1.24-12.91, P = .021) and a lesion ≤1 cm to a venous sinus (adjusted Odds Ratio 10.58, 95% CI 2.93-38.20, P < .001). All patients received standard prophylactic-dose anticoagulant therapy, and none received treatment-dose anticoagulant therapy. No thrombosis-related adverse event was reported. All thromboses presented spontaneous sinus recanalization radiologically at a mean of 89 ± 41 days (range, 7-171).

Conclusion: CVST after supratentorial awake craniotomy is a rare event with satisfactory clinical outcomes and spontaneous sinus recanalization under conservative management without treatment-dose anticoagulant therapy. These findings are comforting to neurosurgeons confronted with postoperative MRI reports suggesting CVST.