2025 Poster Presentations
P454: MANAGEMENT OF DURAL VENOUS SINUS THROMBOSIS FOLLOWING MICROSURGICAL RESECTION OF VESTIBULAR SCHWANNOMA
Evangeline Bambakidis, BS1; Dana Defta, MD2; Sepideh Amin-Hanjani, MD2; Sarah Mowry, MD3; Nicholas Bambakidis, MD2; 1Case Western Reserve University School of Medicine; 2University Hospitals Department of Neurosurgery; 3University Hospitals Department of Otolaryngology
Introduction: Dural venous sinus thrombosis (DVST) is a known complication of microsurgical resection of vestibular schwannomas (VS) due to exposure or retraction of these structures. Risk of clinical progression and optimal management of perioperative DVST is relatively understudied. While typically asymptomatic, patients can present with vague neurologic deficits such as headache, seizures, vision changes, or hemorrhage. The classic treatment for DVST is anticoagulation, which is typically contraindicated in the immediate postoperative period. It is unclear if DVST provoked by surgical manipulation should be treated similarly to spontaneous DVST. Conversely, undertreated DVST can lead to venous outflow obstruction or stenosis, elevated intracranial pressure, and dural venous scarring. There is a lack of evidence-based guidelines that weigh patient characteristics, risk factors, and complications for the management of these patients. The aim of this study is to contribute towards the paucity of literature regarding DVST following VS and aid in the development of a standardized treatment protocol.
Methods: A retrospective chart review of patients with VS who underwent surgical resection of VS from 2013 to 2022 was conducted at a single institution. Postoperative radiology reports were screened for evidence of DVST. Demographic data, surgical approach, hypercoagulable risk factors, DVST management, and complications were assessed.
Results: Of 162 patients who underwent surgery for VS resection, preliminary results yielded nine (5.6%) patients with postoperative DVST. Eight (88.9%) were female, seven (77.8%) were translabyrinthine approach, and two (22.3%) were retrosigmoid. Two patients were treated with anticoagulation alone, two with anticoagulation and antiplatelet, and four with antiplatelet therapy alone. One patient was managed by observation. Six (75%) of the eight patients receiving treatment did not experience any complications. One patient (12.5%) experienced a fat graft site hematoma while undergoing aspirin and lovenox therapy. One patient required recanalization via venous thrombectomy despite anticoagulation.
Conclusion: Postoperative DVST is an uncommon complication of VS resection, and management can vary. When looking at incidence by surgical approach, 8.2% of all translabyrinthine cases resulted in a DVST versus only 2.7% of total retrosigmoid approaches, suggesting a possible increased occurrence via the translabyrinthine approach. Optimal management is unclear, although anticoagulation is likely to be associated with higher risk of bleeding complications as opposed to antiplatelet therapy. Both appear to be equally efficacious in preventing further complications.