OBJECTIVE Neurosurgical intervention may increase the risk of developing cerebral vein and dural sinus thrombosis (CVT). The clinical management of CVT in postoperative patients remains unclear. This retrospective study explores the disease occurrence, associated risk factors, and outcomes in patients with tumors who developed CVT after craniotomy. METHODS A retrospective analysis and review of patient records in those who had undergone cranial tumor removal within the authors' neurosurgical department was performed. In so doing, the authors identified a cohort of patients who developed CVT postoperatively. The study included patients who presented to the department between January 2004 and December 2013. RESULTS Of 2286 patients with intracranial lesions who underwent craniotomy, 35 (1.5%) went on to develop CVT. The authors identified the semisitting position (OR 7.55, 95% CI 3.73-15.31, p < 0.001); intraoperative sinus injury (OR 1.5, 95% CI 3.57-15.76, p < 0.001); and known CVT risk factors (OR 7.77, 95% CI 2.28-21.39, p < 0.001) as predictors of CVT development. Of note, 19 patients (54.3%) had good outcomes (modified Rankin Scale Score 0-1), whereas 9 patients (25.7%) had suffered dependency or death (modified Rankin Scale Score 4-6) at last follow-up. Intracerebral hemorrhage (OR 21.27, 95% CI 1.59-285.01, p = 0.02) and delayed delivery of an intermediate dose of low-molecular-weight heparin anticoagulation (OR 24.12, 95% CI 2.08-280.13, p = 0.01) were associated with unfavorable outcomes. CONCLUSIONS Only a minority of patients undergoing craniotomy for tumor removal develop CVT, and the majority of those who do develop CVT recover well. Early administration of an intermediate dose of low-molecular-weight heparin anticoagulation might be considered once CVT is diagnosed.
Keywords: CVT = cerebral vein and dural sinus thrombosis; ICH = intracerebral hemorrhage; IQR = interquartile range; ISCVT = International Study on Cerebral Vein and Dural Sinus Thrombosis; LMWH = low-molecular-weight heparin; anticoagulation; craniotomy; intracranial; mRS = modified Rankin Scale; neurosurgery; oncology; risk factors; sinus thrombosis.