QLTI-15. VENOUS SINUS THROMBOSIS AFTER BRAIN TUMOR RESECTION

Abstract

Abstract Post-operative venous sinus thrombosis (POVST) is an uncommon complication from a craniotomy for brain tumor resection. There are few data in how to treat POVST, including the use of anticoagulation and follow-up. It has been found that POVST is more common in dural-based lesions especially located on or near a sinus, however treatment has not been standardized. We retrospectively reviewed our POVST cases between January 2018 to December 2020 for brain tumor resection, whether we chose to start anticoagulation or not, and the eventual outcome. We also performed a literature review on the topic to compare findings and management. We identified 14 cases of POVST; 8 of the cases were for extra-axial masses. Of the 14, 6 POVST had clot involving the superior sagittal sinus (SSS), with 3 being discharged with a direct oral anticoagulant (DOAC) and one being discharged on warfarin. With transverse sinus involvement, 6 cases were noted (with no SSS clot), with 2 started on a DOAC and 2 being started on ASA 81mg. In the sigmoid sinus there were 2 cases and did not receive anticoagulation. Of the 14 total cases, 1 was symptomatic (new-onset seizures) necessitating surgical recanalization and no other cases had symptoms attributed to the POVST. Two patients died from unrelated reasons prior to receiving any outpatient imaging, and all other patients had recanalization of their involved sinuses within 2-5 months. There were no complications in patients receiving anticoagulation. Our literature review didn't show a standardized method in POVST treatment. There is also disagreement in what anticoagulation should be used, and if it is necessary. Based on our retrospective analysis and literature review, if the clot is symptomatic, involves the SSS, or propagates, we recommend anticoagulation. Outside the SSS, it should be determined on a case-by-case basis, but anticoagulation may not be necessary.