Otogenic Lateral Sinovenous Thrombosis in Children: A Case Series from a Single Centre and Narrative Review

Management of Otogenic Sigmoid Sinus Thrombosis: A Systematic Review on the Role of Anticoagulation and its Outcome

To provide a systematic review on the use of additional anticoagulation in the management of otogenic sigmoid sinus thrombosis when compared with the cohort not receiving the anticoagulation. A systematic review until 2021 was done and relevant studies were screened. Based on a selective criteria, a database is constituted which were then rearranged and studied. 16 articles were selected with 113 patients. The group who received anticoagulation had more complications (23.33%) in comparison (21.74%), whereas the recanalization was successful in the anticoagulated group, 76.67%, as against 39.13%. In 74/90 patients who underwent mastoidectomy with anticoagulation, the recanalization and complication were 72.97% and 25.68% respectively. The second group with 16/90 patients who received conservative treatment, the recanalization and complication rates were 93.75% and 12.50% respectively. The third group with 23 patients were treated with mastoidectomy and antibiotics but didn't receive anticoagulants in which the recanalization achieved in 39.13% with a complication rate of 21.74%. For those patients who underwent mastoidectomy with concurrent anticoagulation, 44 showed radiological evidence of recanalization, and in sixteen patients that received the same treatment, no recanalization was achieved whereas in patients who received conservative treatment with anticoagulation, 12 patients showed recanalization and finally, for the patients underwent surgery without anticoagulation, five patients achieved recanalization and 7 did not become recanalized (14.29%). Recanalization seems more pronounced in those who were anticoagulated, but, did not seem to influence the clinical outcome. Complications were more in those who were undergone surgery with or without anticoagulation.

Intracranial thrombosis after ventriculoperitoneal shunting

We report a case of intracranial thrombosis (IT) after ventriculoperitoneal shunting (VPS). We reviewed the literature to highlight the importance of considering the possibility of cerebral venous thrombosis following VPS, even though it is a rarely reported complication. A 14-year-old boy underwent distal catheter replacement due to its short size that was detected during a routine consultation. Five days postoperatively, he experienced nausea, vomiting, seizures, and headache. Although a diagnosis of meningitis was considered, diagnosis of IT was eventually confirmed through computed tomography venography and gadolinium magnetic angioresonance. The patient subsequently underwent anticoagulant therapy, which led to complete resolution of symptoms. In this report, we suggest a possible association between VPS and IT, which is a complication that is not commonly reported. The literature suggests that decreased blood flow due to over-drainage of CSF after VPS causes decreased head pressure, culminating in venous stasis and consequent thrombosis. In addition, the literature describes associations between IT and lumbar puncture (LP); therefore, it is important to consider the possibility of IT following these procedures.