Lateral dural sinus thrombosis in childhood

Objectives: To present etiology, diagnosis, and treatment of dural sinus th rombosis (DST) in children. To discuss the diagnostic role of contrast-enha nced computed tomography (CECT) and to evaluate the controversial treatment modalities of anticoagulation, surgical drainage of the infected sinus, an d ligation of the internal jugular vein (IJV). Study Design: Retrospective chart review and analysis of computed tomography (CT) scans and follow-zap visits to document the clinical outcome. Methods: Between 1986 and 1996, CT scans of 15 children revealed DST, These patients were further investigate d. Results: The etiology could be divided in three groups: group A, infecti on (6); group B, trauma (6); and group C, coagulation disorders. There were neither symptoms nor clinical findings specifically related to DST but rat her, these were related to the underlying disease or condition (otitis medi a, skull base fractures). Diagnosis was made by CECT in all cases. Fusobact erium necrophorum was found in 4 of 6 patients in group A. Early mastoidect omy with incision and drainage of the thrombosed sigmoid sinus was performe d in patients in group A. Postoperative intravenous (IV) heparin was given; however, no ligation of the IJV became necessary. In all patients in group C, protein C or protein S deficiency, or both, was detected. Conclusions: CECT with adequate window-level settings allows the diagnosis of a DST with high sensitivity. Treatment of choice for septic DST consists of administr ation of antibiotics and early surgical drainage. We recommend anticoagulat ion therapy in children with septic DST during their hospitalization.