Bilateral Transverse Sinus Thrombosis following Craniotomy and Cranial Reconstruction for Sagittal Craniosynostosis

Aaron Mohanty, Krystalynne Godwin, Mohammad Fares Albitar, Gautam Malkani

Research output: Contribution to journalArticle

Abstract

Introduction: Craniotomy and cranial reconstruction is the most common procedure for children older than 6 months with craniosynostosis. Dural sinus thrombosis after this surgery has not been well reported in the literature. Case Presentation: This 2-year-old child underwent a bilateral craniotomy and cranial reconstruction for sagittal craniosynostosis. He had a partial thickness tear of the wall of the right transverse sinus which was uneventfully managed. Postoperative imaging showed evidence of bilateral thrombosis of the transverse sinus with a small occipital hemorrhage. He was started on low-molecular-weight heparin. Follow-up imaging showed nonprogression of the thrombosis. Four days later, he developed pulmonary hemorrhage, had an extended period of low oxygenation and hypotension with acute respiratory distress syndrome, and had to be ventilated for a prolonged period. Follow-up MRI showed evidence of extensive bilateral cortical hypointensities possibly due to hypoxemia. At the last follow-up, he continued to be grossly neurologically impaired. Conclusion: Thrombosis of the dural sinuses is a very rare occurrence after an extensive craniotomy and cranial reconstruction. However, it should be considered during the postoperative period and, if diagnosed, it should be treated with anticoagulants. Avoiding a direct sinus injury during reflection of the craniotomy flap and covering the exposed sinus with moist cottonoids during the surgery is advocated to prevent sinus thrombosis.

Original languageEnglish (US)
JournalPediatric Neurosurgery
DOIs
StateAccepted/In press - Jan 1 2019

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Lateral Sinus Thrombosis
Craniosynostoses
Craniotomy
Intracranial Sinus Thrombosis
Transverse Sinuses
Hemorrhage
Low Molecular Weight Heparin
Adult Respiratory Distress Syndrome
Tears
Postoperative Period
Hypotension
Anticoagulants
Thrombosis
Lung
Wounds and Injuries

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery
  • Clinical Neurology

Cite this

Bilateral Transverse Sinus Thrombosis following Craniotomy and Cranial Reconstruction for Sagittal Craniosynostosis. / Mohanty, Aaron; Godwin, Krystalynne; Albitar, Mohammad Fares; Malkani, Gautam.

In: Pediatric Neurosurgery, 01.01.2019.

Research output: Contribution to journalArticle

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