Pediatric cerebral venous sinus thrombosis or compression in the setting of skull fractures from blunt head trauma

David S. Hersh, Nir Shimony, Mari Groves, Gerald F. Tuite, George Jallo, Ann Liu, Tomas Garzon-Muvdi, Thierry A.G.M. Huisman, Ryan Felling, Joseph A. Kufera, Edward S. Ahn

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: Pediatric cerebral venous sinus thrombosis has been previously described in the setting of blunt head trauma; however, the population demographics, risk factors for thrombosis, and the risks and benefits of detection and treatment in this patient population are poorly defined. Furthermore, few reports differentiate between different forms of sinus pathology. A series of pediatric patients with skull fractures who underwent venous imaging and were diagnosed with intrinsic cerebral venous sinus thrombosis or extrinsic sinus compression is presented. METHODS: The medical records of patients at 2 pediatric trauma centers were retrospectively reviewed. Patients who were evaluated for blunt head trauma from January 2003 to December 2013, diagnosed with a skull fracture, and underwent venous imaging were included. RESULTS: Of 2224 pediatric patients with skull fractures following blunt trauma, 41 patients (2%) underwent venous imaging. Of these, 8 patients (20%) had intrinsic sinus thrombosis and 14 patients (34%) displayed extrinsic compression of a venous sinus. Three patients with intrinsic sinus thrombosis developed venous infarcts, and 2 of these patients were treated with anticoagulation. One patient with extrinsic sinus compression by a depressed skull fracture underwent surgical elevation of the fracture. All patients with sinus pathology were discharged to home or inpatient rehabilitation. Among patients who underwent follow-up imaging, the sinus pathology had resolved by 6 months postinjury in 80% of patients with intrinsic thrombosis as well as 80% of patients with extrinsic compression. All patients with intrinsic thrombosis or extrinsic compression had a Glasgow Outcome Scale score of 4 or 5 at their last follow-up. CONCLUSIONS: In this series of pediatric trauma patients who underwent venous imaging for suspected thrombosis, the yield of detecting intrinsic thrombosis and/or extrinsic compression of a venous sinus was high. However, few patients developed venous hypertension or infarction and were subsequently treated with anticoagulation or surgical decompression of the sinus. Most had spontaneous resolution and good neurological outcomes without treatment. Therefore, in the setting of pediatric skull fractures after blunt injury, venous imaging is recommended when venous hypertension or infarction is suspected and anticoagulation is being considered. However, there is little indication for pervasive venous imaging after pediatric skull fractures, especially in light of the potential risks of CT venography or MR venography in the pediatric population and the unclear benefits of anticoagulation.

Original languageEnglish (US)
Pages (from-to)258-269
Number of pages12
JournalJournal of Neurosurgery: Pediatrics
Volume21
Issue number3
DOIs
StatePublished - Mar 1 2018

Fingerprint

Intracranial Sinus Thrombosis
Skull Fractures
Craniocerebral Trauma
Venous Thrombosis
Pediatrics
Thrombosis
Phlebography
Pathology
Infarction
Depressed Skull Fracture
Population
Hypertension
Glasgow Outcome Scale
Surgical Decompression
Nonpenetrating Wounds

Keywords

  • Anticoagulation
  • Dural sinus thrombosis
  • Pediatric
  • Skull fracture
  • Trauma
  • Venous sinus thrombosis

ASJC Scopus subject areas

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

Cite this

Pediatric cerebral venous sinus thrombosis or compression in the setting of skull fractures from blunt head trauma. / Hersh, David S.; Shimony, Nir; Groves, Mari; Tuite, Gerald F.; Jallo, George; Liu, Ann; Garzon-Muvdi, Tomas; Huisman, Thierry A.G.M.; Felling, Ryan; Kufera, Joseph A.; Ahn, Edward S.

In: Journal of Neurosurgery: Pediatrics, Vol. 21, No. 3, 01.03.2018, p. 258-269.

Research output: Contribution to journalArticle

Hersh, David S. ; Shimony, Nir ; Groves, Mari ; Tuite, Gerald F. ; Jallo, George ; Liu, Ann ; Garzon-Muvdi, Tomas ; Huisman, Thierry A.G.M. ; Felling, Ryan ; Kufera, Joseph A. ; Ahn, Edward S. / Pediatric cerebral venous sinus thrombosis or compression in the setting of skull fractures from blunt head trauma. In: Journal of Neurosurgery: Pediatrics. 2018 ; Vol. 21, No. 3. pp. 258-269.
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abstract = "OBJECTIVE: Pediatric cerebral venous sinus thrombosis has been previously described in the setting of blunt head trauma; however, the population demographics, risk factors for thrombosis, and the risks and benefits of detection and treatment in this patient population are poorly defined. Furthermore, few reports differentiate between different forms of sinus pathology. A series of pediatric patients with skull fractures who underwent venous imaging and were diagnosed with intrinsic cerebral venous sinus thrombosis or extrinsic sinus compression is presented. METHODS: The medical records of patients at 2 pediatric trauma centers were retrospectively reviewed. Patients who were evaluated for blunt head trauma from January 2003 to December 2013, diagnosed with a skull fracture, and underwent venous imaging were included. RESULTS: Of 2224 pediatric patients with skull fractures following blunt trauma, 41 patients (2{\%}) underwent venous imaging. Of these, 8 patients (20{\%}) had intrinsic sinus thrombosis and 14 patients (34{\%}) displayed extrinsic compression of a venous sinus. Three patients with intrinsic sinus thrombosis developed venous infarcts, and 2 of these patients were treated with anticoagulation. One patient with extrinsic sinus compression by a depressed skull fracture underwent surgical elevation of the fracture. All patients with sinus pathology were discharged to home or inpatient rehabilitation. Among patients who underwent follow-up imaging, the sinus pathology had resolved by 6 months postinjury in 80{\%} of patients with intrinsic thrombosis as well as 80{\%} of patients with extrinsic compression. All patients with intrinsic thrombosis or extrinsic compression had a Glasgow Outcome Scale score of 4 or 5 at their last follow-up. CONCLUSIONS: In this series of pediatric trauma patients who underwent venous imaging for suspected thrombosis, the yield of detecting intrinsic thrombosis and/or extrinsic compression of a venous sinus was high. However, few patients developed venous hypertension or infarction and were subsequently treated with anticoagulation or surgical decompression of the sinus. Most had spontaneous resolution and good neurological outcomes without treatment. Therefore, in the setting of pediatric skull fractures after blunt injury, venous imaging is recommended when venous hypertension or infarction is suspected and anticoagulation is being considered. However, there is little indication for pervasive venous imaging after pediatric skull fractures, especially in light of the potential risks of CT venography or MR venography in the pediatric population and the unclear benefits of anticoagulation.",
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AU - Tuite, Gerald F.

AU - Jallo, George

AU - Liu, Ann

AU - Garzon-Muvdi, Tomas

AU - Huisman, Thierry A.G.M.

AU - Felling, Ryan

AU - Kufera, Joseph A.

AU - Ahn, Edward S.

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N2 - OBJECTIVE: Pediatric cerebral venous sinus thrombosis has been previously described in the setting of blunt head trauma; however, the population demographics, risk factors for thrombosis, and the risks and benefits of detection and treatment in this patient population are poorly defined. Furthermore, few reports differentiate between different forms of sinus pathology. A series of pediatric patients with skull fractures who underwent venous imaging and were diagnosed with intrinsic cerebral venous sinus thrombosis or extrinsic sinus compression is presented. METHODS: The medical records of patients at 2 pediatric trauma centers were retrospectively reviewed. Patients who were evaluated for blunt head trauma from January 2003 to December 2013, diagnosed with a skull fracture, and underwent venous imaging were included. RESULTS: Of 2224 pediatric patients with skull fractures following blunt trauma, 41 patients (2%) underwent venous imaging. Of these, 8 patients (20%) had intrinsic sinus thrombosis and 14 patients (34%) displayed extrinsic compression of a venous sinus. Three patients with intrinsic sinus thrombosis developed venous infarcts, and 2 of these patients were treated with anticoagulation. One patient with extrinsic sinus compression by a depressed skull fracture underwent surgical elevation of the fracture. All patients with sinus pathology were discharged to home or inpatient rehabilitation. Among patients who underwent follow-up imaging, the sinus pathology had resolved by 6 months postinjury in 80% of patients with intrinsic thrombosis as well as 80% of patients with extrinsic compression. All patients with intrinsic thrombosis or extrinsic compression had a Glasgow Outcome Scale score of 4 or 5 at their last follow-up. CONCLUSIONS: In this series of pediatric trauma patients who underwent venous imaging for suspected thrombosis, the yield of detecting intrinsic thrombosis and/or extrinsic compression of a venous sinus was high. However, few patients developed venous hypertension or infarction and were subsequently treated with anticoagulation or surgical decompression of the sinus. Most had spontaneous resolution and good neurological outcomes without treatment. Therefore, in the setting of pediatric skull fractures after blunt injury, venous imaging is recommended when venous hypertension or infarction is suspected and anticoagulation is being considered. However, there is little indication for pervasive venous imaging after pediatric skull fractures, especially in light of the potential risks of CT venography or MR venography in the pediatric population and the unclear benefits of anticoagulation.

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KW - Trauma

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