Abstract
Sinus sigmoideus (lateral sinus) thrombophlebitis (LTS), a rare but potentially devastating complication of otitis media, is managed by broad spectrum antibiotics, surgery and anticoagulation. The management of intracranial dural sinuses thrombosis/thromboflebitis is still controversial and ambiguous.
Traditionally, post-operative anticoagulation is achieved by intravenous low-molecular weight heparin derivatives followed by oral warfarin. There has been minimal literature to date regarding their use for the management of LST.
Study design: A retrospective review was conducted of 7 children of otogenic LTS admitted between 1993 and 2005 to our division. All patients underwent i.v. antibiotics, anticoagulation therapy, and 6 of them mastoid surgery.
We describe the inical symptoms, effectiveness of antithrombotic therapy, and outcome. Conclusion: In all of our children LTS was the result of acute otitis media.
The age of them was by chance just between 6 and 7 years of age, there wasn't sex prevalence, but in 6 cases the right side was affected. No one suffered from frequent acute otitis media, nor chronic one.
Magnetic resonance imaging plays a major role in determining diagnosis and treatment plans. The treatment was succesful in all cases, conservative surgical mastoid intervention including eradication of the perisinus absceses seems to be effective.
In our cases, antithrombotic therapy has been found to be a safe and effective treatment. We performed careful antiXa/INR controls and didn't observe any hemorrhagic complications.
Angio-MRI showed recanalization of the sinuses in all patients (6 patients - average 33 days, 1 girl @ of a year). There was no additional mortality.