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 |