Dural Venous Sinus Thrombosis After Vestibular Schwannoma Surgery: The Anticoagulation Dilemma

Abstract

Abstract INTRODUCTION Dural venous sinus thrombosis (DVST) is a relatively understudied complication of vestibular schwannoma (VS) surgery. Several studies have examined this topic however, there is limited data on the incidence, clinical progression, and proper management of this patient population. The objective of this study is to retrospectively evaluate the incidence, risk factors, and downstream complications associated with postoperative DVST after vestibular schwannoma surgery. METHODS A retrospective review was performed for patients undergoing surgery for vestibular schwannoma between November 2008 and July 2018 at a single institution. Demographic data was collected including tumor and surgical characteristics along with postoperative course. All postoperative imaging was reviewed for incidence of DVST. This cohort of patients was further characterized and analyzed. RESULTS A total of 63 patients underwent resection of their vestibular schwannoma. The incidence of DVST was 34.9%. Tumor size was correlationally significant (P = .051) at 2.75 vs 2.12 cm greatest diameter. The translabyrinthine approach was most prevalent (68.2%). The operative time was greater in the DSVT group, at an average of 6.69 hr vs 4.87 in the no DSVT cohort (P = .04). The side of the thrombosis was ipsilateral to the tumor and surgery in all patients. The sigmoid sinus was the most commonly involved (95.5%). The average time to diagnosis was 3.24 mo. In all 85% of the patients had a co-dominant, or thrombus contralateral to the dominant sinus. All patients were asymptomatic. No patients were treated with anticoagulation. Resolution of thrombus was seen in 5 (22.7%) of the patients on last follow up imaging. There were no hemorrhagic complications or sequalae from DVST. CONCLUSION Our overall incidence of DVST was (34.9%) of 63 patients who underwent vestibular schwannoma surgery. All of the patients were asymptomatic and none of the patients were anticoagulated. In our experience, continuing to observe asymptomatic patients did not lead to any adverse events.