Venous sinus thrombosis in traumatic brain injury: a major trauma centre experience

Background This study explores the presentation, management and outcomes of traumatic venous sinus thrombosis (VST) and identifies risk factors associated with poor outcomes. Methods This study is a retrospective review of all patients with VST secondary to trauma who presented to a major trauma cen...

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Bibliographic Details
Published in:	Acta neurochirurgica Vol. 163; no. 9; pp. 2615 - 2622
Main Authors:	Harris, Lauren, Townsend, Dominic, Ingleton, Rose, Kershberg, Alice, Uff, Chris, O’Halloran, Philip J., Offiah, Curtis, McKenna, Grainne S.
Format:	Journal Article
Language:	English
Published:	Vienna Springer Vienna 01-09-2021 Springer Nature B.V
Subjects:	Brain Injuries, Traumatic - complications Brain Injuries, Traumatic - diagnostic imaging Brain Injuries, Traumatic - epidemiology Brain trauma Cerebral infarction Child Child, Preschool Contusions Fractures Hematoma Humans Infant Interventional Radiology Male Medicine Medicine & Public Health Minimally Invasive Surgery Neurology Neuroradiology Neurosurgery Original Article - Brain trauma Patients Prospective Studies Retrospective Studies Risk factors Sinus Thrombosis, Intracranial - diagnostic imaging Sinus Thrombosis, Intracranial - epidemiology Sinus Thrombosis, Intracranial - etiology Sinuses Skull Subarachnoid hemorrhage Surgical Orthopedics Thrombosis Trauma Trauma Centers Traumatic brain injury Ventricle Anticoagulation Venous sinus thrombosis Traumatic brain injury Cerebral venography
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Summary:	Background This study explores the presentation, management and outcomes of traumatic venous sinus thrombosis (VST) and identifies risk factors associated with poor outcomes. Methods This study is a retrospective review of all patients with VST secondary to trauma who presented to a major trauma centre, between April 2015 and January 2020. VST was confirmed by CT venogram and a consultant neuroradiologist. Results Forty-six patients were identified (38 male), mean age of 43 (range 12–78) and median follow-up 10.2 months (range 0.7–39.1). Fifty-two percent presented as a severe traumatic brain injury, and all had an associated skull fractures overlying the sinus. Ninety-six percent had cerebral contusions, 96% had an intracranial haematoma, 91% had traumatic subarachnoid haemorrhage (tSAH) and 22% had acute cerebral infarction. Thirty-seven percent of the VSTs were occlusive. Fifty-eight percent had sustained, unprovoked intracranial pressure (ICP) spikes (> 20 mmHg). Fifty percent underwent surgical intervention—20% external ventricular drain and 46% craniotomy/craniectomy. Nine percent were treated with anticoagulation and 4% with antiplatelets, at a median of 13.5 days and 9.5 days post-injury, with no additional complications. Age > 60 was associated with poor outcome (GOS of 3–5) ( p = 0.0098). On follow-up CT, 52% of the VSTs remained unchanged, 29% re-canalised, 14% improved and 5% worsened, independent of treatment. Conclusions This study demonstrated a higher incidence of VST in severe TBI and strong associations with skull fractures, cerebral contusions, tSAH, raised ICP and surgical intervention. Management was inconsistent, with no difference in outcome with or without anticoagulation. Larger, prospective cohort studies are needed to better understand this condition and establish evidence-based guidelines.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0001-6268 0942-0940
DOI:	10.1007/s00701-021-04916-x