Surgical Thrombectomy for Extensive Cerebral Venous Sinus Thrombosis after COVID-19 Vaccination : A Novel Surgical Technique and Literature Review

Chung, Yuwhan; Ryu, Jiwook; Choi, Seok Keun

doi:.0..

Journal of Korean Neurosurgical Society > Accepted Articles

Case Report

doi: https://doi.org/10.3340/jkns.2023.0026 [Accepted]

Surgical Thrombectomy for Extensive Cerebral Venous Sinus Thrombosis after COVID-19 Vaccination : A Novel Surgical Technique and Literature Review

Yuwhan Chung¹

, Jiwook Ryu²

, Seok Keun Choi²

¹Department of Medicine, Graduate School, Kyung Hee University, Seoul, Korea
²Department of Neurosurgery, Kyung Hee University Hospital, Seoul, Korea

Correspondence

Seok Keun Choi ,Tel: +82-2-958-8385, Fax: +82-2-958-8380, Email: nscsk@hanmail.net

Received: February 1, 2023; Accepted: February 25, 2023. Published online: March 2, 2023.

ABSTRACT

Surgical treatment of refractory and extensive cerebral venous sinus thrombosis (CVST) has limited applications. Here, we describe an open, direct sinus thrombectomy in the early phase of extensive CVST. A 49-year-old man with extensive CVST that occurred after the coronavirus disease 2019 (COVID-19) vaccination and affected the drainage of the Labbé vein presented with clinical deterioration and left temporal hemorrhagic infarction. Since the patient had extensive CVST, we determined that systemic anticoagulation and endovascular treatment were not suitable treatment options. Therefore, we decided on an emergency surgical treatment and performed direct surgical thrombectomy. We followed extended suboccipital approach and made multiple incisions on the sinuses, exposing the posterior superior sagittal sinus to the transverse sigmoid junction. Consequently, the clinical condition of the patient dramatically improved, resulting in a favorable outcome with a modified Rankin Scale score of 0. Performing emergency open surgical thrombectomy was a technically feasible treatment option that recanalized obstructed sinuses. Importantly, the patient recovered with a good clinical outcome. Early maximal surgical thrombectomy is an effective and lifesaving method to treat extensive CVST with hemorrhagic infarction.

Key Words: Cerebral venous sinus thrombosis · Surgical thrombectomy · Vein of Labbé · Neurosurgery