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Table 1 Summary of the reported cases of otogenic sinus thrombosis in children from 2011 to 2020

From: Pediatric otogenic cerebral venous sinus thrombosis: a case report and a literature review

Author, year, nation, reference N.
of patient
Age Gender
(M/F)
Onset symptoms Neurological complication Sinus involved Intracranial complication Surgical treatment Anticoagulation
(Duration)
Antibiotic Treatment Clinical
Outcome
Radiological Outcome
Bevan, 2020, United Kingdom
[8]
11 3–11 years 7 M
4 F
Not reported Papilledema, Abducens nerve palsy, strabismus, visual defect, seizures 2 SS
2 TS
4 SS + TS + IJV
1 SS + IJV
1 SS + TS
1 IJV
1 epidural abscess
11 otitic hydrocephalus
7mastoidectomy
3 mastoidectomy and myringotomy
1 mastoidectomy, myringotomy, craniotomy
LMWH;
Rivoxaban
(not clarified)
Broad spectrum antibiotic Not clarified Not clarified
Coutinho, 2018, Portugal
[6]
16 2–16 years 7 M
9 F
Ear pain, headache, lethargy, nausea, vomiting, fever
neck stiffness
Abducens nerve palsy, papilledema 4 SS
2 TS
6 SS, TS
4 SS, TS, IJV
5 epidural abscess
3 otitic hydrocephalus
1 epidural abscess, meningitis
16 Mastoidectomy, transtimpanic ventilation tube
7 perioperative sigmoid sinus exposure
3 drainage perisinus empyema
5 craniotomy
UFH; LMWH; warfarin
(3–12 months)
Broad spectrum antibiotic 2 neuro-ophtalmological impairment
1 HDAD
1 non-specific behaviour disorder
3 partial recanalization
7 complete recanalization
Scorpecci, 2018, Italy
[9]
25 1–14 years 17 M
8 F
Ear pain,signs of mastoiditis, headache, othorrea, neck stiffness VI cranial nerve
palsy, altered consciousness, papilledema, vertigo
16 SS
4 SS + TS
1 SS + cavernous sinus
1 SS + sagittal sinus
2 SS + jugular bulb
2 epidural abscess
1 cerebellar abscess
16 mastoidectomy and tympanostomy tube insertion
3 abscess evacuation through an occipital craniotomy approach
LMWH
(at least 2 months)
Broad spectrum antibiotic 1 persistent bilateral
optic nerve atrophy and subsequent impaired visual acuity
20 complete recanalization
2 partial recanalization
3 no complete follow-up
Scherer, 2017, USA
[10]
1 6 years M Headache, ear pain, blurry vision, nausea, vomiting Papilledema,
Abducens nerve palsy
SS, TS, IJV None Mastoidectomy, myringotomy, tube placement LMWH
(6 months)
Broad spectrum antibiotic No sequelae Complete recanalization
Ryan, 2016,
USA
[11]
7 6–15 years 4 M
3 F
Fever, ear pain, othorrea, neck stiffness Papilledema 7 SS
7 TS
5 IJV
2 epidural abscess
2 otitic hydrocephalus
1 meningitis
1 cavernous sinus thrombosis
Mastoidectomy and tympanostomy tube
2 epidural abscess drainage
5 patients; not clarified Broad spectrum antibiotic 1 right visual-field deficit
6 no sequelae
In 1 patient persistent thrombosis after 9 months.
Not clarified for the other patients
Zanoletti, 2015, Italy
[7]
8 2–7 years 4 M
4F
Fever, headache, ear pain
lethargy
6 papilledema
3 diplopia
2 photophobia
1 facial paralisis
8 SS
6 TS
4 IJV
1 epidural abscess 5 mastoidectomy
2 transtimpanic drainage
2 myringocentesis
UFH; LMWH
(3 months)
Broad spectrum antibiotic No sequelae 5 complete recanalization
1 partial recanalization
1 sinus entirely distrupted
Rosdy, 2014, Hungary
[12]
10 4–8 years 6 M
4 F
Fever, headache, ear pain, otorrhea, lethargy, vomiting, neck stiffness,
torcicollis
9 papilledema
2 abducens nerve palsy
3 ataxia
10 SS
5 TS
3 IJV
4 perisinous abscess
1 epidural abscess
1 cerebellar abscess
10 mastoidectomy
2 thrombectomy
1 IJV ligation
1 epidural abscess drainage
8 patients LMWH
(3–6 months months)
Broad spectrum antibiotic 1 unilateral visual deficit 5 complete recanalization
2 partial recanalization
Funamura, 2014,
USA
[5]
5 1–15 years 4 M
1 F
Fever, ear pain, headache, nausea, vomiting, otorrhea, lethargy 1 patient presented seizures after intracranial hemorrage 5 SS
4 TS
2 IJV
2 epidural abscess
1 brain abscess
4 mastoidectomy
1 myringotomy with tympanostomy tube
1 IJV drainage
1 craniotomy with drainage of brain abscess
3 epidural abscess drainage
3 patients UFH (3 days-3 weeks) followed by LMWH (3–6 months) Broad spectrum antibiotic 1 epilepsy and developmental delay
1 headache
2 partial recanalization
1 complete recanalization
Ulanovski, 2014, Israel
[13]
24 7 months-12 years 10 M
14 F
Fever, ear pain 1 abducens nerve palsy
3 seizures
9 SS
6 SS + TS
4 SS + IJV
4 SS + TS + IJV
1 cavernous sinus
11 epidural involvement
5 temporal bone osteomyelitis
21 mastoidectomy + decompression of the sinus
3 none intervention
22 patients LMWH (3–6 months) Broad spectrum antibiotic No sequelae 7 complete recanalization
6 partial recanalization
2 persistence obstructed vessels
Au, 2013, USA
[14]
1 14 years M Fever, ear pain, otorrhea, headache, vomiting, fatigue, visual allucinations, blurry vision Not reported TS + SS Epidural abscess Myringotomy, tube placement, mastoidectomy Not performed Broad spectrum antibiotic No sequelae Complete recanalization
Novoa, 2013, Switzerland
[15]
9 1–13 years 6 M
3 F
Fever, ear pain, otorrhea, headache, vomiting, apathy 2 abducens nerve palsy
1 vertigo
5 SS
3 SS+ IJV
1 SS + TS
4 otitis hydorcephalus
4 subperiostal abscess
2 epidural abscess
Mastoidectomy and tympanostomy tubes 6 patients LMWH (3–6 months)
3 patients UFH (2,7,21 days) followed by LMWH in 1 patient (3 months), acetylsalicylate in 1 patient (6 months), phenprocoumon in 1 patient (11 months)
Broad spectrum antibiotic 1 patient presented moderate hearing loss, persistence of increased intracranial pressure, headache, legasthenia and atrophy of optic nerve 7 complete recanalization
2 persistent recanalization
Csakanyi, 2013, Hungary
[16]
8 4–8 years 6 M
2 F
Fever, ear pain, headache, lethargy, nausea, vomiting, neck stiffness, torcicollis 1 ataxia
1 bradycardia
2 SS
1 SS + TS
4 SS + TS + IJV
1 only granulation
Not reported 6 mastoidectomy + decompression of sinus
1 mastoidectomy + thrombectomy
1 mastoidectomy + thrombectomy + IJV ligation
6 patients LMWH
(2–6 months)
Broad spectrum antibiotic 1 permanent visual loss 7 complete recanalization
In patient with IJV involvement a good collateral circulation was observed
Van Munster, 2013, The Netherlands
[17]
1 3 years F Fever, left side otorrhea, vomiting abducens nerve palsy Sinus thrombosis
(not specified)
Cerebellar empyema Mastoidectomy + thrombectomy LMWH
(not clarified)
Broad spectrum antibiotic No sequelae Complete recanalization
Inkuchi, 2013, Japan
[18]
1 5 years M Nausea, vomiting, headache None TS + SS + IJV Not reported Ventricle-peritoneal shunt + ventilation tube insertion Not performed Not reported No sequelae Complete recanalization
Sitton, 2012, United States
[19]
7 2–15 years 5 M
2 F
Fever, ear pain, otorrhea, vomiting, headache, neck stiffness, mastoid tenderness Diplopia SS (2)
SS + TS (3)
SS + IJV (2)
1 subperiostal abscess 3 mastoidectomy + myringotomy and tube placement
1
mastoidectomy + aspiration of sinus
1
myringotomy, tube placement and drainage of subperiostal abscess
2
myringotomy, tube placement
6 patients LMWH. Of these 3 patients previously received UFH and 4 switched to warfarin.
(1.5–6 months)
Broad spectrum antibiotic No sequelae 6 complete recanalization
1 no resolution
Zangari, 2012, Italy
[20]
5 3–10 years 4 M
1 F
Fever, headache, asthenia, vomiting, signs of mastoiditis Diplopia, photophobia 3 SS
2 SS + TS
None 2 mastoidectomy
3 none
LMWH for 3 months. In 1 patient LMWH was followed by oral anticoagulant for 6 months. Broad spectrum antibiotic No sequelae 3 complete recanalization
1 partial recanalization
1 no resolution
Ropposch, 2012, Austria
[21]
6 3–15 years 6 M Headache, neck stiffness, fever, ear pain, post-auricular pain and erythema, otorrhea 1 Vertigo
1 Abducens nerve palsy
3 SS + TS
3 SS + IJV
None 3 mastoidectomy + thrombectomy
2
mastoidectomy
+ ligation IJV
UFH followed by LMWH
(3 months)
Broad spectrum antibiotic 1 hydrocephalus and papilledema that rgressed after 6 months 3 complete recanalization
Ghosh, 2011, USA
[22]
13 5 months-18 years 9 M
4 F
Headache, vomiting, fever, otorrhea 4 abducens nerve palsy
1 facial nerve palsy
5 papilledema
Ataxia
8 TS
5 TS + SS + IJV
None 4 mastoidectomy
5 mastoidectomy + myringotomy and ventilation tube
1 myringotomy with tube ventilation
3 LMWH
(6 months)
Broad spectrum antibiotic 4 transient hearing loss
1 permanent hearing loss
3 complete recanalization
2 partial recanalization
Bielecki, 2011, Poland
[23]
5 3–9 years 3 M
2 F
Headache, ear pain, fever, vomiting 6 papilledema
3 diplopia
3 facial nerve
palsy
1 SS
1 SS + TS
1 SS + IJV
1 SS + TS + IJV
1 SS + TS + IJV + SGS
None 5 mastoidectomy + ventilation tube placement 4 UFH, followed by LMWH and acenocoumarol
(6 months)
Broad spectrum antibiotic No sequelae 5 partial or complete recanalization (not clarified)
Viswanatha, 2011, India
[24]
9 8–12 years 6 M
3 F
Headache, ear pain, fever, vomiting, vertigo 1 Facial nerve palsy and
lateral rectus palsy
TS 4 cerebellar abscess
3
meningitis, 1 temporal lobe
abscess
1 otitic hydrocephalus
9 mastoidectomy + thrombectomy
drainage of intracranial
abscesses
Not performed Broad spectrum antibiotic No sequelae Not reported
Neilan, 2011, USA
[25]
15 6 months - 14 years 10 M
5 F
Not reported 5 diplopia 2 SS
3 SS + TS
1 SS + IJV
8 SS + TS + IJV
1 SS + CS + IJV
5 otitic hydrocephalus 15 mastoidectomy and tympanostomy tube placement
+
3 needle decompression
3 osseous decompression
6 venotomy
12 patients LMWH
(6 weeks-6 months)
Not reported Not reported 4 persistence obstructed vessels
2 complete recanalization
8 partial recanalization
  1. SS Sigmoid sinus, TS Transverse sinus, IJV Internal jugular vein, SGS Sagittal sinus, UFH Unfractionated heparin, LMWH Low-molecular-weight heparin, HDAD Hyperactivity disorder and attention deficit