Management of lateral sinus thrombosis.

OBJECTIVES: Review the clinical signs and symptoms, management, bacteriology and outcomes of patients treated for lateral sinus thrombosis. STUDY DESIGN: A retrospective review of six patients, treated from 1993 through 1998, with an intraoperatively confirmed diagnosis of lateral sinus thrombosis. METHODS: All charts from 1993 through 1998 coded for sinus thrombosis, meningitis, brain abscess, otitic hydrocephalus, subdural abscess, and mastoidectomy were reviewed. Operative reports, radiological examinations, laboratory data, culture data and other pertinent data were reviewed. RESULTS: The presenting symptoms ranged from headache to mental status changes. All patients had a history of chronic ear disease and all had at least one additional intracranial complication. The range of additional intracranial complications included otitic hydrocephalus, epidural abscess, and brain abscess. All of the infections were polymicrobial, with a predominance of anaerobes. There were no mortalities; morbidities included anacusis, acute respiratory distress syndrome, reoperation, seizures, septic cardiomyopathy, transfusion, ventriculoperitoneal shunt and nutritional supplementation. CONCLUSION: In patients with otologic disease, complaints of headache, earache or photophobia should warrant an evaluation. The presence of lateral sinus thrombosis mandates further investigation for additional intracranial complications. Conservative surgical intervention, consisting of removal of all perisinus infection and needle aspiration of the sinus, has been found to be effective. Lateral sinus thrombosis is an uncommon complication of otitis media, with potentially significant morbidities, necessitating a high index of suspicion.     

Pediatric otogenic lateral sinus thrombosis recanalization

Objective

To describe the recovery outcomes in pediatric patients with otogenic lateral sinus and internal jugular vein thrombosis.

Methods

An inpatient database from a tertiary care pediatric hospital was queried from 1999 to 2010 for the diagnosis code [325] thrombosis of intracranial venous sinus. Demographics, extent of thrombosis, surgical intervention, use of anticoagulation, and the presence of recanalization on follow-up imaging was collected.

Results

Fifteen patients (10 male, 5 female) were identified with otogenic lateral sinus thrombosis. Eleven patients (73.3%) had evidence of thrombus in the transverse sinus, while 10 patients (66.7%) had thrombus in the internal jugular vein, and one patient (6.7%) had thrombus in the cavernous sinus. Five patients (33%) had otitic hydrocephalus. Twelve patients (80%) underwent operative manipulation of the lateral sinus including: three decompressions 20%, three needle aspirations 20%, and six venotomies with evacuation of clot or pus 40%. Twelve patients were anticoagulated with low molecular weight heparin, and three patients were not anticoagulated. Ten of fourteen patients (71.4%) who underwent follow-up magnetic resonance venography had evidence of partial (57.1%) or complete (14.3%) recanalization of the lateral sinus. All five patients with otitic hydrocephalus recovered as determined by a normal fundoscopic exam and recovery of abducens paresis.

Conclusion

Recanalization of the lateral intracranial venous sinus occurred in the majority of the patients in this series. The role of operative intervention and/or anticoagulation remains unclear.     

Management of otogenic lateral sinus thrombosis

ObjectiveTo evaluate the changing clinical course and trends in management of otogenic lateral sinus thrombosis (OLST), in view of the rarity of the said lesion and antibiotic abuse.MethodsA retrospective case study was done in 6 patients referred to our tertiary care centre with OLST over a period of three years from May 2007 to May 2010: Department of Otorhinolaryngology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi – a tertiary care university teaching hospital under central government of India.Medical records of all the patients were scrutinized and data pertaining to patient profile, type of chronic suppurative otitis media (CSOM), clinical course with any other complication and management were tabulated. The said data was scientifically analyzed w.r.t. current medical literature on the subject.ResultsClinically, it was observed that all patients had protracted CSOM – attico antral type, with history of rampant misuse of antibiotics. The attack of OLST in each case was triggered off by an acute attack of suppurative otitis media. Moreover, in all the cases OLST was masquerading as an intra-cranial complication, with no specific clinical features thereby causing missed diagnosis initially. All these patients were diagnosed by CT scan, and underwent modified radical mastoidectomy (MRM) with needle aspiration of sinus under antibiotic cover. The said treatment protocol resulted in excellent prognosis with no morbidity or mortality whatsoever. Pathologically, cholesteatoma was detected in 5 of the six cases with one case having only granulations.ConclusionsIn this era of antibiotic abuse, the clinical presentation of OLST has altered substantially, and mimics other intra-cranial complication with vague signs and symptoms. There are conflicting views in contemporary medical literature regarding management of OLST. In our experience, MRM with needle aspiration under antibiotic cover is the treatment of choice for all cases of OLST associated with CSOM attico antral disease/cholesteatoma disease.     

Lateral sinus thrombosis

Twelve cases of lateral sinus thrombosis, which occurred as a complication of attico antral type of chronic otitis media, are reported. Management includes broad spectrum intravenous antibiotics and surgery. Radical mastoidectomy with incision of the lateral sinus and removal of its content was done for all cases. There were no deaths. The prognosis of lateral sinus thrombosis is good if treatment is instituted early with broad-spectrum antibiotics and surgery.     

Persistent petrosquamosal sinus: Underlying cause of otitic hydrocephalus with lateral sinus thrombosis

Lateral sinus thrombosis (LST) occurs when a middle ear infection disseminates directly via bone erosion or disseminates indirectly through the venous networks. The petrosquamosal sinus (PSS) is the residual accessory dural sinus connecting intracranial to extracranial drainage. This report describes a case of a patient with persistent PSS running through the mastoid in context of otitic hydrocephalus with LST. To identify PSS, enhanced CT and reconstructed image from CT venography were more useful than MRI. The possibility of persistent PSS running through the mastoid should be considered if LST without marked inflammation and bone erosion is noted.     

Visual and neurologic deterioration in otogenic lateral sinus thrombosis: 15 year experience

Objectives

Otogenic lateral sinus thrombosis is a rare complication of acute otitis media whose clinical presentation has changed with the early use of antibiotics. The aim of this study was to analyze the changing clinical signs, vaccination status, therapeutic management and outcome of these patients.

Methods

Retrospective chart review of 10 children treated with otogenic lateral sinus thrombosis in a tertiary level teaching hospital in Budapest, Hungary, from January 1998 till August 2013.

Results

Patients were divided into Early and Late presenting groups. In the Early presenting group, sepsis developed within one week after the onset of acute otitis media. At admission otological symptoms were predominant. The Late presenting group experienced acute otitis media several weeks prior to presentation and in this group neurologic symptoms dominated the clinical picture at admission. All patients received antibiotics. Eight of them were also treated with low molecular weight heparin. All children underwent cortical mastoidectomy. After surgery, the clinical signs of elevated intracranial pressure transiently worsened. This manifested as progression of papilledema in seven children, causing severe visual disturbance in two cases. After medical treatment and serial lumbar punctures all patients except one recovered. This child has permanent visual acuity failure of 0.5 D unilaterally. At one year follow up complete and partial recanalization were noted in five and two patients, respectively.

Conclusions

After mastoidectomy the signs of elevated intracranial pressure can transiently worsen, papilledema can progress. Daily bedside monitoring of visual acuity and regular ophthalmoscopy with neurologic examination is recommended during hospitalization. Close follow up is advised up to one year. When the dominant sinus is occluded, the clinical scenario is more protracted and severe.     

Prothrombotic factors in children with otitis media and sinus thrombosis

OBJECTIVE: Venous sinus thrombosis (VST) is the second most common intracranial complication of acute otitis media (AOM). There is some evidence that hereditary and acquired prothrombotic disorders are risk factors for VST. The aim of the present study was to evaluate whether children with AOM complicated VST have a prothrombotic tendency, which might have important therapeutic and preventive implications. STUDY DESIGN: Retrospective. METHODS: The files of children hospitalized at Schneider Children's Medical Center of Israel, a tertiary referral center, from 1999 to 2002, because of AOM complicated by acute mastoiditis and VST were reviewed. All children underwent laboratory work-up for hypercoagulability. RESULTS: Seven children met the study criteria. Of these, five had prothrombotic disorders, namely elevated levels of lipoprotein apolipoprotein (Lp[a]) (n = 4), antibodies to beta 2-glycoprotein and to cardiolipin (markers of antiphospholipid syndrome) (n = 4), and heterozygosity for factor V Leiden mutation (n = 1). One child had three abnormalities, two children had two abnormalities, and two children had one abnormality. CONCLUSIONS: A prothrombotic tendency may exist in children with AOM complicated by mastoiditis and VST. Further studies are needed to evaluate its extent.     

Otogenic lateral sinus thrombosis: Case series and controversies

Objectives

The aim of this study is to (1) report the clinical presentation, treatment, and sequelae in a series of pediatric patients with otogenic lateral sinus thrombosis and (2) to review the most controversial aspects of management of this rare intracranial complication of otitis media.

Methods

Retrospective chart review of inpatients treated for central venous thrombosis at a tertiary care facility between 1996 and 2012.

Results

Five pediatric patients (four male, one female) were identified with otogenic lateral sinus thrombosis. Age at presentation ranged from 13 months to 15 years. All underwent a surgical procedure, ranging from a simple myringotomy with tympanostomy tube placement to tympanomastoidectomy and internal jugular vein ligation or craniotomy. Three were anticoagulated with unfractionated heparin with subsequent transition to low molecular weight heparin of variable duration. One patient developed a non-life-threatening intracranial hemorrhage while on long-term anticoagulation. Follow-up imaging, when available, did not directly correlate complete thrombus resolution with use of anticoagulation or with persistent symptoms.

Conclusions

Otogenic lateral sinus thrombosis is a rare intracranial complication of otitis media with significantly reduced morbidity and mortality in the modern era of antibiotic treatment, surgical intervention, and anticoagulation therapy. Due to the rarity of this condition today, the recommended extent of surgical intervention and need for routine anticoagulation are unclear, and requires further data to determine definitively.     

海绵窦区肿瘤的显微外科治疗

目的观察海绵窦区肿瘤临床特征和手术治疗效果。方法对我院2000年1月～2007年12月住院的36例海绵窦区肿瘤进行回顾性分析并随访。结果36例均为良性肿瘤,其中神经鞘瘤15例,脑膜瘤10例,海绵状血管瘤5例,表皮样囊肿3例,神经纤维瘤2例,黑色素瘤1例。手术治疗33例,其中全切除25例,次全切除7例,部分切除1例,无手术死亡病例。术后脑神经功能好转6例,出现新的脑神经功能障碍或功能障碍加重者15例。随访3～6个月,未见肿瘤复发。结论海绵窦区肿瘤多为良性肿瘤,好发于中年女性。海绵窦区良性肿瘤的手术治疗预后良好。     

An unusual complication of CSOM — Lateral sinus thrombosis with lung abscess: A clinicoradiological study

Aims To present a case report of a child presenting with lateral sinus thrombosis with bilateral multiple lung abscesses as a rare consequence of CSOM with an emphasis on the radiological findings. Material and methods An 11-year-old male child with a history of pyrexia of unknown origin, right-sided torticollis, cough with expectoration and right ear discharge was referred to us from department of paediatric medicine. Chest examination revealed dull areas on percussion and areas with bronchial breath sounds on auscultation bilaterally. Otological examination revealed right attic retraction pocket filled with cholesteatoma, post-auricular tenderness and Greisinger’s sign along with foul smelling muco-purulent discharge. Results Routine blood investigations revealed normocytic normochromic anaemia, polymorpho-nuclear leucocytosis and raised ESR. Audiological investigations showed a right-sided mixed hearing loss. Digital radiography of chest showed multiple thin walled cavities involving all of the lung zones bilaterally. USG (Ultrasonography) of neck showed thrombosis of right internal jugular vein. CT scanning of head, neck and thorax showed soft tissue collection within the right mastoid with erosion of posterior wall & presence of gas bubble in the right sigmoid sinus and thrombosis of right internal jugular vein and multiple abscess cavities occupying both lung parenchyma. The patient was initially managed with conservative antibiotic therapy for lung abscess followed by radical mastoidectomy and thromboembolectomy from the lateral sinus. Conclusion Otogenic lung abscess though rare in this present postantibiotic era, it can occur in underprivileged and poor population like our country.     

海绵窦区肿瘤的手术治疗

目的探讨海绵窦区肿瘤的手术入路方式。方法总结1995年~2004年以来经显微手术治疗的海绵窦区肿瘤23例,其中海绵窦原发肿瘤7例;毗邻侵及海绵窦的肿瘤16例,后者包括侵袭性垂体腺瘤7例,脑膜瘤6例,神经纤维瘤3例。回顾其术前CT及MRI特征、手术方法。结果23例海绵窦区肿瘤经显微手术治疗,全切8例,部分切除15例,效果良好,无死亡。结论海绵窦区手术是神经外科的难题,合适的手术入路和良好的显微手术技能是手术成功的关键。     

上颌窦气化与牙源性上颌窦炎的相关性分析

目的 探讨上颌窦气化与牙源性上颌窦炎发病的关系.方法 回顾性分析牙源性上颌窦炎患者鼻窦CT中双侧牙槽突骨质厚度、牙槽突气化深度,冠状位上颌窦高度及矢状位对角线长度,观察牙源性上颌窦炎患者双侧上颌窦气化程度的差异.结果 牙源性上颌窦炎患者患侧上颌骨牙槽突厚度:(5.67±1.79)mm,健侧上颌骨牙槽突厚度:(7.88±...