Pediatric lateral sinus thrombosis: retrospective case series and literature review.
ABSTRACT A comparison between the literature and our management of pediatric patients presenting with otogenic lateral sinus thrombosis.
A retrospective case series of five pediatric patients.
Four patients were treated at BC Children's Hospital, whereas the fifth patient was treated in New Westminster, BC. All were treated between 1994 and 2001.
A retrospective chart review was conducted with a literature review for otogenic lateral sinus thrombosis.
Treatment success was based on resolution of acute infection and neurologic symptoms.
Five patients, four males and one female, aged 2 to 14 years were reviewed. Three patients were treated successfully without mastoidectomy. One patient received a mastoidectomy that yielded no pus or granulation tissue within the mastoid cavity. One patient required a mastoidectomy after failure to respond to bilateral myringotomy and tympanostomy tube insertion. Although no pus was seen in the mastoid cavity, perisinus pus was found after unroofing the sigmoid sinus plate; free flow of blood was obtained on needle aspiration of the sinus, and the sinus was not surgically opened.
The current literature states that the management of otogenic lateral sinus thrombosis includes high-dose intravenous antibiotics with a mastoidectomy and possible opening of the sinus. In our retrospective case series, three of five patients recovered completely without mastoidectomy, and a fourth had a mastoidectomy deemed to have been unnecessary. We conclude that intravenous antibiotics and insertion of a tympanostomy tube are sufficient treatment for selected cases of otogenic lateral sinus thrombosis. Mastoidectomy with possible opening of the sinus should be reserved for patients refractory to the above conservative treatment.
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ABSTRACT: To evaluate the demographics, diagnosis, management, and outcomes of lateral sinus thrombosis in a pediatric population, and to propose a new treatment algorithm. Retrospective review of seven patients. Patients averaged 7.4 years of age. They commonly presented with headache and otalgia (seven of seven patients), and nausea and vomiting (six of seven patients). All patients had abnormal otoscopy, and four of seven patients had a lateral rectus palsy, but fever was not always present (only three of seven patients). All patients underwent MRI with venography (MRV) for diagnosis. All patients were admitted to the hospital (average length of stay 8 days) and treated with antibiotics (six of seven patients with i.v. ceftriaxone). Five of seven were treated with simple mastoidectomy and concurrent middle ear ventilation tubes; two patients received only medical treatment. The average follow up was 114 months (range 33-387 months). Two patients had long-term sequela: one had persistent mild lateral gaze diplopia and another had unilateral moderate to severe high frequency sensorineural hearing loss. Six of seven patients had follow up imaging (average 15 months, range 1-40 months). Four of six patients showed recanalization of the lateral sinus on repeat imaging. Based on the current experience in the modern era of MRV and broad-spectrum antibiotics, a new treatment algorithm is proposed. Lateral sinus thrombosis is an uncommon cranial complication of otitis media. The advent of non-invasive diagnosis and effective broad-spectrum antibiotics has drastically decreased the mortality and altered the diagnostic and treatment paradigm.International journal of pediatric otorhinolaryngology 03/2009; 73(4):581-4. · 0.85 Impact Factor
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ABSTRACT: Cerebral venous sinus (sinovenous) thrombosis (CSVT) in childhood is a rare, but underrecognized, disorder, typically of multifactorial etiology, with neurologic sequelae apparent in up to 40% of survivors and mortality approaching 10%. There is an expanding spectrum of perinatal brain injury associated with neonatal CSVT. Although there is considerable overlap in risk factors for CSVT in neonates and older infants and children, specific differences exist between the groups. Clinical symptoms are frequently nonspecific, which may obscure the diagnosis and delay treatment. While morbidity and mortality are significant, CSVT recurs less commonly than arterial ischemic stroke in children. Appropriate management may reduce the risk of recurrence and improve outcome, however there are no randomized controlled trials to support the use of anticoagulation in children. Although commonly employed in many centers, this practice remains controversial, highlighting the continued need for high-quality studies. This article reviews the literature pertaining to pediatric venous sinus thrombosis.Neurosurgery clinics of North America 07/2010; 21(3):511-27. · 1.73 Impact Factor