Abstract：
Venous sinus thromboses (VSTs) are rare complications of neurosurgical procedures in the proximity of the dural sinuses. Surgery of the posterior cranial fossa (PCF) and particularly of the cerebellopontine angle (CPA) shows increased risk of VST. VST management is challenging because anticoagulant therapy must be balanced with the risk of postoperative bleeding. We performed a systematic review and meta-analysis to summarize the most important neuroradiologic and clinical aspects of VST after PCF/CPA surgery.
We performed a comprehensive literature search to identify articles reporting data on VST after PCF/CPA surgery. We selected only comparative studies providing adequate neuroimaging assessing VST and a control group.
We included 13 articles reporting 1855 patients. VST occurred in 251/1855 cases (estimated incidence, 17.3%; 95% confidence interval [CI], 12.4%-22.2%). Only presigmoid approach (odds ratio [OR], 2.505; 95% CI, 1.161-5.404; P = 0.019) and intraoperative sinus injury (OR, 8.95; 95% CI, 3.43-23.34; P < 0.001) showed a significant association with VST. VST-related symptoms were reported in 12/251 patients with VST (pooled incidence, 3.1%; 95% CI, 1%-5.2%). In particular, we found a significantly increased OR of cerebrospinal fluid leak (OR, 3.197; 95% CI, 1.899-5.382; P < 0.001) and cerebrospinal fluid dynamic alterations in general (OR, 3.625; 95% CI, 2.370-5.543; P < 0.001). Indications for VST treatment were heterogeneous: 58/251 patients underwent antithrombotics, with 6 treatment-related bleedings. Recanalization overall occurred in 56.4% (95% CI, 40.6%-72.2%), with no significant difference between treated and untreated patients. However, untreated patients had a favorable outcome.
VST is a relatively frequent complication after PCF/CPA surgery and a presigmoid approach and intraoperative sinus injury represent the most significant risk factors. However, the clinical course is generally benign, with no advantage of antithrombotic therapy.
We performed a comprehensive literature search to identify articles reporting data on VST after PCF/CPA surgery. We selected only comparative studies providing adequate neuroimaging assessing VST and a control group.
We included 13 articles reporting 1855 patients. VST occurred in 251/1855 cases (estimated incidence, 17.3%; 95% confidence interval [CI], 12.4%-22.2%). Only presigmoid approach (odds ratio [OR], 2.505; 95% CI, 1.161-5.404; P = 0.019) and intraoperative sinus injury (OR, 8.95; 95% CI, 3.43-23.34; P < 0.001) showed a significant association with VST. VST-related symptoms were reported in 12/251 patients with VST (pooled incidence, 3.1%; 95% CI, 1%-5.2%). In particular, we found a significantly increased OR of cerebrospinal fluid leak (OR, 3.197; 95% CI, 1.899-5.382; P < 0.001) and cerebrospinal fluid dynamic alterations in general (OR, 3.625; 95% CI, 2.370-5.543; P < 0.001). Indications for VST treatment were heterogeneous: 58/251 patients underwent antithrombotics, with 6 treatment-related bleedings. Recanalization overall occurred in 56.4% (95% CI, 40.6%-72.2%), with no significant difference between treated and untreated patients. However, untreated patients had a favorable outcome.
VST is a relatively frequent complication after PCF/CPA surgery and a presigmoid approach and intraoperative sinus injury represent the most significant risk factors. However, the clinical course is generally benign, with no advantage of antithrombotic therapy.
摘要：
背景：静脉窦血栓形成（VST）是硬脑膜窦附近神经外科手术的罕见并发症。后颅窝（PCF），尤其是小脑桥脑角（CPA）的手术显示VST的风险增加。VST管理具有挑战性，因为抗凝治疗必须与术后出血风险相平衡。我们进行了系统回顾和荟萃分析，以总结PCF/CPA手术后VST最重要的神经放射学和临床方面。
方法：我们进行了全面的文献检索，以确定PCF/CPA手术后VST的手稿报告数据。我们仅选择了提供足够的神经影像学评估VST和对照组的比较研究。
结果：我们纳入了报告1855例患者的13篇论文。251/1855例发生VST（估计发生率：17.3%；95CI：12.4%-22.2%）。只有乙状窦入路(OR2.505;95CI:1.161-5.404;p=0.019)和术中窦损伤(OR8.95;95CI:3.43-23.34;p<.001)与VST有显著相关性。在12/251例VST患者中报告了VST相关症状（合并发生率：3.1％；95CI：1％-5.2％）。特别是,我们发现,脑脊液漏出的OR显著增加(OR3.197;95CI:1.899-5.382;p<.001),脑脊液动态改变总体上显著增加(OR3.625;95CI:2.370-5.543;p<.001).VST治疗的适应症是异质性的：58/251例患者接受了抗血栓药物治疗，与6治疗相关的出血。在56.4%(CI95%:40.6%-72.2%)的患者中,在治疗和未治疗的患者之间没有显著差异。然而，未经治疗的患者有一个良好的结果。
结论：VST是PCF/CPA手术后相对常见的并发症，乙状窦入路和术中窦道损伤是最重要的危险因素。然而,临床过程通常是良性的，抗血栓治疗没有优势。
方法：我们进行了全面的文献检索，以确定PCF/CPA手术后VST的手稿报告数据。我们仅选择了提供足够的神经影像学评估VST和对照组的比较研究。
结果：我们纳入了报告1855例患者的13篇论文。251/1855例发生VST（估计发生率：17.3%；95CI：12.4%-22.2%）。只有乙状窦入路(OR2.505;95CI:1.161-5.404;p=0.019)和术中窦损伤(OR8.95;95CI:3.43-23.34;p<.001)与VST有显著相关性。在12/251例VST患者中报告了VST相关症状（合并发生率：3.1％；95CI：1％-5.2％）。特别是,我们发现,脑脊液漏出的OR显著增加(OR3.197;95CI:1.899-5.382;p<.001),脑脊液动态改变总体上显著增加(OR3.625;95CI:2.370-5.543;p<.001).VST治疗的适应症是异质性的：58/251例患者接受了抗血栓药物治疗，与6治疗相关的出血。在56.4%(CI95%:40.6%-72.2%)的患者中,在治疗和未治疗的患者之间没有显著差异。然而，未经治疗的患者有一个良好的结果。
结论：VST是PCF/CPA手术后相对常见的并发症，乙状窦入路和术中窦道损伤是最重要的危险因素。然而,临床过程通常是良性的，抗血栓治疗没有优势。
