Radiographic Evaluation, Management, and Long-term Follow-up of Dural Venous Sinus Thrombosis in Surviving Gunshot Wounds to the Head: A Case Series. (16th November 2020)

• Record Type: Journal Article
• Authors: Chryssikos, Timothy; Kim, Kevin; Wessell, Aaron; Stokum, Jesse A; Oliver, Jeffrey; Cannarsa, Gregory; Gaddam, Durga S; Lomangino, Cara D; Scarboro, Maureen; Kole, Matthew; Sansur, Charles; Aarabi, Bizhan; Schwartzbauer, Gary
• Is Part Of: Neurosurgery. Volume 67(2010)Supplement 1
• Publication Date: 2020-11-16
• Subjects: Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1093/neuros/nyaa447_495
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract: INTRODUCTION: Gunshot wounds to the head (GSWH) can impact dural venous sinuses (DVS). Long-term fate of DVS thrombosis with or without treatment in surviving GSWH is not known. METHODS: We retrospectively reviewed surviving GSWH from 2009–2019 with pretest suspicion for DVS involvement and dedicated venous imaging (CTV, DSA, or MRV). RESULTS: 38/47 patients (80.9%) had DVS involvement, including 10 with extrinsic compression alone from hematoma/bone/ballistic fragment, 17 with both compression and thrombosis, 1 with thrombosis and transection, and 10 with thrombosis only. There were 9 partially and 19 completely occlusive thrombus (28 total). Mean clinical follow-up was 1098.3 days. There was follow-up imaging in 31 (mean 144.7 days). 16 of 28 with thrombus were placed on anticoagulation or antiplatelet (AC/AP) regimen (0.25-19 months), with 1 complication (mortality). In AC/AP patients, there were 3 partial and 13 complete thrombus. Superior sagittal sinus (SSS), torcula (T), transverse sinus (TS), sigmoid sinus (SS), and internal jugular (IJ) were involved in 3, 1, 12, 10, and 4, respectively. Thrombus was unchanged in 3, improved in 4, and resolved in 7 patients on AC/AP with follow-up imaging. In non-AC/AP patients, there were 6 partial and 6 complete thrombus and involvement of SSS, T, TS, SS, and IJ in 6, 1, 6, 3, and 3, respectively. Thrombus was unchanged in 3, improved in 1, and resolved in 3 patients not on AC/AP with follow-up imaging. Extrinsic compression was unchanged in 12, improved in 4, and resolved in 3 follow-up studies. There was no progression of existing thrombus or new/delayed thrombus in any patient (31 total). There was no significant relationship between thrombus and entry point, depressed fracture, or pneumocephalus. Mean GOS was 3.8 in 16 AC/AP-treated thrombus patients, 4.4 in 12 non-AC/AP thrombus patients, 4 in 10 with extrinsic compression only, and 4 in 9 with no DVS involvement. CONCLUSION: There was no progression of DVS thrombosis, regardless of treatment. This series provides the first long-term assessment of DVS thrombosis in surviving GSWH and contributes to understanding the indications, safety, and efficacy of AC/AP in this population.