Management of Traumatic Cerebral Venous Sinus Thrombosis: A United Kingdom and Ireland Survey on Practice Variation
Traumatic cerebral venous sinus thrombosis (tCVST) is an increasingly recognized sequela of traumatic brain injury (TBI), with skull fractures and extradural hematomas overlying venous sinuses recognized as risk factors. Although it may be treated with anticoagulation, the decision to treat tCVST is...
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Mary Ann Liebert
2024-11-01
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| Series: | Neurotrauma Reports |
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| Online Access: | https://www.liebertpub.com/doi/10.1089/neur.2023.0118 |
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| author | Sheikh M. B. Momin David J. Davies Philip J. O’Halloran Antonio Belli Tonny Veenith Ramesh Chelvarajah |
| author_facet | Sheikh M. B. Momin David J. Davies Philip J. O’Halloran Antonio Belli Tonny Veenith Ramesh Chelvarajah |
| author_sort | Sheikh M. B. Momin |
| collection | DOAJ |
| description | Traumatic cerebral venous sinus thrombosis (tCVST) is an increasingly recognized sequela of traumatic brain injury (TBI), with skull fractures and extradural hematomas overlying venous sinuses recognized as risk factors. Although it may be treated with anticoagulation, the decision to treat tCVST is nuanced by the risk of new or worsening hemorrhage. Presently, there are no guidelines on the investigation and management of tCVST. Therefore, we conducted a UK- and Ireland-wide practice variation survey. A 17-question survey was sent via Google Forms to neurosurgeons and intensive care doctors of at least ST3 (registrar) level and above in the UK and Ireland and distributed by the Society of British Neurological Surgeons and investigators of the Sugar or Salt trial between May 9, 2023, and September 15, 2023. Data were extracted from the survey for both qualitative and quantitative analyses. There were 41 respondents to the survey, 18 (43.9%) of whom were consultant neurosurgeons. Fifty-four percent of the respondents performed a computed tomography intracranial venogram to investigate for tCVST where there was a skull fracture overlying or adjacent to a venous sinus, whereas 43.9% performed these at the time of TBI diagnosis. Around three-fourth of the respondents anticoagulate for tCVST, largely within 3 days post-TBI. A range of hemorrhagic and thrombotic complications have been observed following decisions to treat and withhold treatment of tCVST, respectively. Around two-third of the respondents conducted follow-up imaging in confirmed tCVST. None of the respondents had an established departmental protocol for the management of tCVST. This UK- and Ireland-wide survey on the management of tCVST revealed a variation in its diagnosis, treatment, and follow-up with no departmental protocol established. The optimal diagnostic pathway, management protocol, and follow-up of patients with tCVST remain unknown and should be the subject of future studies. |
| format | Article |
| id | doaj-art-4ea4a0b94dfc4afaae6706d95cd07a47 |
| institution | OA Journals |
| issn | 2689-288X |
| language | English |
| publishDate | 2024-11-01 |
| publisher | Mary Ann Liebert |
| record_format | Article |
| series | Neurotrauma Reports |
| spelling | doaj-art-4ea4a0b94dfc4afaae6706d95cd07a472025-08-20T02:31:48ZengMary Ann LiebertNeurotrauma Reports2689-288X2024-11-015154055110.1089/neur.2023.0118Management of Traumatic Cerebral Venous Sinus Thrombosis: A United Kingdom and Ireland Survey on Practice VariationSheikh M. B. Momin0David J. Davies1Philip J. O’Halloran2Antonio Belli3Tonny Veenith4Ramesh Chelvarajah5Department of Neurosurgery, Queen Elizabeth Hospital, Birmingham, UK.Department of Neurosurgery, Queen Elizabeth Hospital, Birmingham, UK.Department of Neurosurgery, Queen Elizabeth Hospital, Birmingham, UK.Department of Neurosurgery, Queen Elizabeth Hospital, Birmingham, UK.Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.Department of Neurosurgery, Queen Elizabeth Hospital, Birmingham, UK.Traumatic cerebral venous sinus thrombosis (tCVST) is an increasingly recognized sequela of traumatic brain injury (TBI), with skull fractures and extradural hematomas overlying venous sinuses recognized as risk factors. Although it may be treated with anticoagulation, the decision to treat tCVST is nuanced by the risk of new or worsening hemorrhage. Presently, there are no guidelines on the investigation and management of tCVST. Therefore, we conducted a UK- and Ireland-wide practice variation survey. A 17-question survey was sent via Google Forms to neurosurgeons and intensive care doctors of at least ST3 (registrar) level and above in the UK and Ireland and distributed by the Society of British Neurological Surgeons and investigators of the Sugar or Salt trial between May 9, 2023, and September 15, 2023. Data were extracted from the survey for both qualitative and quantitative analyses. There were 41 respondents to the survey, 18 (43.9%) of whom were consultant neurosurgeons. Fifty-four percent of the respondents performed a computed tomography intracranial venogram to investigate for tCVST where there was a skull fracture overlying or adjacent to a venous sinus, whereas 43.9% performed these at the time of TBI diagnosis. Around three-fourth of the respondents anticoagulate for tCVST, largely within 3 days post-TBI. A range of hemorrhagic and thrombotic complications have been observed following decisions to treat and withhold treatment of tCVST, respectively. Around two-third of the respondents conducted follow-up imaging in confirmed tCVST. None of the respondents had an established departmental protocol for the management of tCVST. This UK- and Ireland-wide survey on the management of tCVST revealed a variation in its diagnosis, treatment, and follow-up with no departmental protocol established. The optimal diagnostic pathway, management protocol, and follow-up of patients with tCVST remain unknown and should be the subject of future studies.https://www.liebertpub.com/doi/10.1089/neur.2023.0118anticoagulationsurveytraumatic brain injuryvenous sinus thrombosis |
| spellingShingle | Sheikh M. B. Momin David J. Davies Philip J. O’Halloran Antonio Belli Tonny Veenith Ramesh Chelvarajah Management of Traumatic Cerebral Venous Sinus Thrombosis: A United Kingdom and Ireland Survey on Practice Variation Neurotrauma Reports anticoagulation survey traumatic brain injury venous sinus thrombosis |
| title | Management of Traumatic Cerebral Venous Sinus Thrombosis: A United Kingdom and Ireland Survey on Practice Variation |
| title_full | Management of Traumatic Cerebral Venous Sinus Thrombosis: A United Kingdom and Ireland Survey on Practice Variation |
| title_fullStr | Management of Traumatic Cerebral Venous Sinus Thrombosis: A United Kingdom and Ireland Survey on Practice Variation |
| title_full_unstemmed | Management of Traumatic Cerebral Venous Sinus Thrombosis: A United Kingdom and Ireland Survey on Practice Variation |
| title_short | Management of Traumatic Cerebral Venous Sinus Thrombosis: A United Kingdom and Ireland Survey on Practice Variation |
| title_sort | management of traumatic cerebral venous sinus thrombosis a united kingdom and ireland survey on practice variation |
| topic | anticoagulation survey traumatic brain injury venous sinus thrombosis |
| url | https://www.liebertpub.com/doi/10.1089/neur.2023.0118 |
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