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Superior Sagittal Sinus Thrombectomy in Pediatric Head Injury. | LitMetric

AI Article Synopsis

  • Closed head injuries can lead to thrombosis in the cerebral venous sinuses, particularly from skull fractures that affect dural parts, with significant risks like venous congestion and possible life-threatening complications.
  • A 2-year-old girl with a depressed skull fracture and thrombosis in the sagittal sinus was treated successfully with thrombectomy, as anticoagulation was not an option due to intracranial hemorrhage.
  • Traumatic cerebral venous sinus thrombosis in children may differ in treatment approach compared to adults, with a potential need for mechanical thrombectomy when anticoagulants are contraindicated.

Article Abstract

Introduction: Injury and subsequent thrombosis of the cerebral venous sinuses may be caused by closed head injuries secondary to a variety of different mechanisms. Skull fractures can lacerate or otherwise disrupt adjacent dural sinuses. The sequelae of such injuries may include thrombosis and either partial or total occlusion of the sinus, ultimately resulting in significant venous congestion. Sagittal sinus injury is associated with a more serious outcome due to the obligatory flow into the sinus, especially posterior to the coronal suture. In such cases, venous infarction may be a severe and life-threatening complication of head injury.

Case Presentation: A 2-year-old female presented with a depressed skull fracture near the midline and a thrombus in the sagittal sinus. Anticoagulation, the standard treatment cerebral venous sinus thrombosis (CVST), was contraindicated due to intracranial hemorrhage, so immediate thrombectomy was performed with successful neurologic recovery at 9-month follow-up. To our knowledge, this case is the youngest patient documented to receive mechanical thrombectomy for superior sagittal sinus (SSS) thrombosis due to trauma.

Conclusion: Closed head injuries in pediatric patients may be associated with CVST, with resulting venous drainage compromise and profound neurologic sequelae. Unlike adult patients with spontaneous CVST in which anticoagulation are the standard of care, pediatric patients experiencing traumatic CVST may have contraindications to anticoagulants. If the patient has a contraindication to anticoagulation such as intracranial bleeding, endovascular mechanical thrombectomy may be an effective intervention when performed by an experienced neurointerventionalist.

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Source
http://dx.doi.org/10.1159/000538184DOI Listing

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