Douglas M Smith1, Arastoo Vossough2, Gregory A Vorona2, Lauren A Beslow2, Rebecca N Ichord2, Daniel J Licht2. 1. From the Division of Neurology (D.M.S., R.N.I., D.J.L.) and the Department of Radiology (A.V.), Children's Hospital of Philadelphia, PA; the Department of Neurology (D.M.S., R.N.I., D.J.L.), Perelman School of Medicine of the University of Pennsylvania; the Department of Radiology (A.V.), Hospital of the University of Pennsylvania, Philadelphia; Children's Hospital of Richmond at VCU (G.A.V.), VA; and the Departments of Pediatrics and Neurology (L.A.B.), Yale University School of Medicine, New Haven, CT. smithd13@email.chop.edu. 2. From the Division of Neurology (D.M.S., R.N.I., D.J.L.) and the Department of Radiology (A.V.), Children's Hospital of Philadelphia, PA; the Department of Neurology (D.M.S., R.N.I., D.J.L.), Perelman School of Medicine of the University of Pennsylvania; the Department of Radiology (A.V.), Hospital of the University of Pennsylvania, Philadelphia; Children's Hospital of Richmond at VCU (G.A.V.), VA; and the Departments of Pediatrics and Neurology (L.A.B.), Yale University School of Medicine, New Haven, CT.
Abstract
OBJECTIVE: To describe clinical characteristics, imaging findings, morbidity, and mortality in a single-center cohort of 12 pediatric cavernous sinus thrombosis cases and to review all cases available in recent English literature. METHODS: Clinical data and radiographic studies on 12 cases from our institution were analyzed retrospectively. A literature search and review was conducted, with additional cases pooled with the new cohort for an aggregate analysis. RESULTS: Twelve cases of cavernous sinus thrombosis in children from the Children's Hospital of Philadelphia between January 1, 2000, and December 31, 2013, were reviewed. All patients survived to discharge; 3 of 12 (25%) experienced neurologic morbidity. Contrast-enhanced MRI and contrast-enhanced head CT were 100% sensitive for detecting cavernous sinus thrombosis, while noncontrast time-of-flight magnetic resonance venography (TOF MRV) and noncontrast head CT were 0% sensitive. Literature review produced an additional 40 cases, and the aggregate mortality rate was 4 of 52 (8%) and morbidity rate was 10 of 40 (25%). Outcomes did not vary by treatment or with unilateral vs bilateral cavernous sinus involvement. There was a trend toward worse outcomes with fungal infections. CONCLUSION: Our case series demonstrates low morbidity and mortality with early, aggressive surgical, antimicrobial, and anticoagulation therapies. Although anticoagulation and surgery were not associated with significantly different outcomes, more study is needed.
OBJECTIVE: To describe clinical characteristics, imaging findings, morbidity, and mortality in a single-center cohort of 12 pediatric cavernous sinus thrombosis cases and to review all cases available in recent English literature. METHODS: Clinical data and radiographic studies on 12 cases from our institution were analyzed retrospectively. A literature search and review was conducted, with additional cases pooled with the new cohort for an aggregate analysis. RESULTS: Twelve cases of cavernous sinus thrombosis in children from the Children's Hospital of Philadelphia between January 1, 2000, and December 31, 2013, were reviewed. All patients survived to discharge; 3 of 12 (25%) experienced neurologic morbidity. Contrast-enhanced MRI and contrast-enhanced head CT were 100% sensitive for detecting cavernous sinus thrombosis, while noncontrast time-of-flight magnetic resonance venography (TOF MRV) and noncontrast head CT were 0% sensitive. Literature review produced an additional 40 cases, and the aggregate mortality rate was 4 of 52 (8%) and morbidity rate was 10 of 40 (25%). Outcomes did not vary by treatment or with unilateral vs bilateral cavernous sinus involvement. There was a trend toward worse outcomes with fungal infections. CONCLUSION: Our case series demonstrates low morbidity and mortality with early, aggressive surgical, antimicrobial, and anticoagulation therapies. Although anticoagulation and surgery were not associated with significantly different outcomes, more study is needed.
Authors: Nicolien A van der Poel; Maarten P Mourits; Maartje M L de Win; Jonathan M Coutinho; Frederik G Dikkers Journal: Eur Arch Otorhinolaryngol Date: 2018-07-11 Impact factor: 2.503