Management of lateral sinus thrombosis in children

Abstract

Objectives: Lateral sinus thrombosis (LST) is an unusual complication of acute otitis media. Management of this complication is controversial and usually consists of a combination of broad-spectrum antibiotics, surgical drainage, and anticoagulation therapy. Despite the potential severity of this complication, there are few studies in the literature that address management issues related to LST. Methods: This study retrospectively reviews the charts of all patients who presented with LST as a complication of otitis media over a 7-year period at our institution. Results: Forty-nine patients were identified as having a diagnosis of intracranial venous sinus thrombosis. Six of these children (12 %) had this diagnosis in association with acute otitis media (AOM) and mastoiditis. The mean age at presentation was 8 (4–13) years. All patients had received antibiotic treatment for AOM prior to presentation. Three patients (50 %) presented with a sixth-nerve palsy and intracranial hypertension, of which one had bilateral deficits. The diagnosis of LST was made in all patients using computed tomography and magnetic resonance imaging/venography (MRI/V). Treatment included mastoidectomy and intravenous antibiotics in all patients and anticoagulation in four children. The average length of admission was 5 days. There were no long-term sequelae in any of the cases. Conclusion: The diagnosis of LST should be suspected in patients presenting with AOM refractory to appropriate antibiotic therapy, especially when there is concurrent sixth nerve palsy. Diagnosis is best made with MRI/V and treatment should include broad-spectrum antibiotics, mastoidectomy and anticoagulation therapy in selected cases. Prognosis is excellent when LST is adequately managed.