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Year : 2013  |  Volume : 61  |  Issue : 2  |  Page : 180--181

Distant cerebral venous sinus thrombosis in meningioma surgery: A rare complication

Shruti Redhu1, Majid Mohd Abdul2, Paritosh Pandey2, TS Devaragudi1,  
1 Department of Neuroanaesthesia, National Institute of Mental Health and Neurosciences, Bangalore - 560 029, India
2 Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore - 560 029, India

Correspondence Address:
T S Devaragudi
Department of Neuroanaesthesia, National Institute of Mental Health and Neurosciences, Bangalore - 560 029
India




How to cite this article:
Redhu S, Mohd Abdul M, Pandey P, Devaragudi T S. Distant cerebral venous sinus thrombosis in meningioma surgery: A rare complication.Neurol India 2013;61:180-181


How to cite this URL:
Redhu S, Mohd Abdul M, Pandey P, Devaragudi T S. Distant cerebral venous sinus thrombosis in meningioma surgery: A rare complication. Neurol India [serial online] 2013 [cited 2021 Oct 24 ];61:180-181
Available from: https://www.neurologyindia.com/text.asp?2013/61/2/180/111145


Full Text

Sir,

Cerebral venous sinus thrombosis (CVST) is common cause of stroke in young women. [1] CVST following meningioma surgery distant from any major venous sinus is extremely rare. We report one such rare case.

A 62-year-old female presented with progressive visual loss of 1 year duration and headache of 1 month. There was no history of seizures, loss of consciousness, or focal deficits. Cranial computed tomography (CT) scan revealed a suprasellar hyperdense lesion measuring 4 × 3 × 2.6 cm with contrast enhancement. The lesion was further defined with magnetic resonance imaging (MRI) as a tuberculum sella meningioma [Figure 1]a and b. Laboratory parameters, including the coagulation profile, were within normal ranges. The patient underwent a left pterional craniotomy and Simpson's Grade II excision of meningioma. The craniotomy did not extend till the midline, and no veins were coagulated during the procedure. The perioperative course was uneventful, and blood loss was 500 ml. The patient was reversed, but she remained unconscious with bilateral flexion response to painful stimuli and with sluggish reaction of pupils to light. Emergent cranial CT showed diffuse cerebral edema without any operative site hematoma [Figure 1]c. She was electively ventilated and was started on optimum anti-edema measures. However the patient's condition worsened over the next 12 hours and started to have spontaneous decerebration. An urgent MRI of the brain revealed severe diffuse cerebral edema, central herniation, and effacement of the basal cisterns [Figure 1]d along with complete non-filling of superior sagittal and straight sinuses on MR venography suggestive of superior sagittal sinus and straight sinus thrombosis [Figure 1]e and f. Workup for hypercoagulable state including protein C and S was negative. The patient was started on intravenous heparin; however, she rapidly deteriorated in sensorium, and died on the second postoperative day.{Figure 1}

Postoperative cerebral venous infarction has been described in many types of intracranial surgeries, particularly those associated with exposure of venous sinuses or with inadvertent injury of large cerebral veins. Postoperative CVST has been described mostly in surgeries for parasagittal meningiomas and in interhemispheric approaches for excision of intraventricular lesions. Raza et al., reported a series of 110 patients with parasagittal meningiomas, and the incidence of postoperative CVST was 7%. [2] Unusual cause of CVST in the perioperative period include venous thrombosis following spinal anesthesia. [3] However, superior sagittal sinus thrombosis following a surgery non-contiguous from the site of surgery has not been described. The etiology of the superior sagittal sinus thrombosis in this patient was unclear; however, hypercoagulable states associated with intracranial tumors, particularly meningiomas might be the cause. Brecknell et al. reported the development of disseminated intravascular coagulation during resection of a meningioma, and attributed it to the secretion of tissue factor from the meningioma. [4] Weinberg et al. also reported the development of hypercoagulability in a patient with intracranial tumor. [5] Probably the occurrence of CVST in this patient could be related to some of these abnormalities. In conclusion, this is a rare case of CVST following excision of a meningioma non-contiguous to the site of surgery. The probable cause for the thrombosis was hypercoagulable state secondary to the meningioma.

References

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