Die Sinusvenenthrombose – eine seltene Komplikation der akuten Mastoiditis und des Cholesteatoms

Zusammenfassung

Hintergrund: Die Sinusvenenthrombose (SVT) ist eine seltene Komplikation der akuten Mastoiditis und des infizierten Cholesteatoms. In der internationalen Literatur wurde bisher wenig über die systematische Untersuchung bei V.a. eine SVT dokumentiert. In dieser Untersuchung wurden die klinischen, intraoperativen und therapeutischen Befunde der Patienten diskutiert.

Patienten und Methoden: Es werden retrospektiv 7 Patienten mit radiologischem V.a. eine SVT dargestellt. Bei allen Patienten erfolgte eine Mastoidektomie mit Darstellung des Hirnsinus und Überprüfung dessen Blutführung.

Ergebnisse: 4 Patienten hatten eine Thrombose des Sinus sigmoideus und 3 Patienten hatten eine Phlebitis des Sinus. Patienten mit einer SVT hatten zusätzlich zur Otalgie Schwindel, Cephalgien, Meningismus, Surditas oder eine Facialisparese. Postoperative MRT-Untersuchungen zeigten eine Rekanalisation des Sinus in allen Fällen. 2 Patienten entwickelten einen 2-zeitigen Kleinhirnabszess.

Schlussfolgerung: Die Symptome der SVT sind unspezifisch. Neurologische Beschwerden können bei einer Mastoiditis hinweisend sein. Die Therapie besteht in der intravenösen Antibiotikagabe und der operativen Fokussanierung. Immer sollte im Rahmen der Mastoidektomie die Darstellung des Sinus erfolgen und dessen Blutführung überprüft werden. Im Falle einer Thrombose ist kann überdies die Antikoagulantientherapie indiziert sein. Zum Ausschluss eines 2-zeitigen Hirnabszesses empfiehlt sich eine Kontroll-MRT 7–14 Tage postoperativ.

Abstract

Lateral Sinus Thrombosis – A Rare Complication of an Acute Mastoiditis or Infected Cholesteatoma

Background: Lateral sinus thrombosis (LST) is a rare but threatening complication of an acute mastoiditis or infected cholesteatoma. Currently only very few papers are available in the literature dealing with the systematic investigation of patients with suspected LST. The purpose of the present study was to evaluate the clinical, intraoperative and therapeutic findings of patients with particular disease.

Patients and Methods: For this retrospective study the clinical records of 7 patients which were admitted for a suspected LST were evaluated. All patients underwent mastoidectomy with exposition of the lateral sinus and investigating of its blood flow.

Results: A LST was confirmed in 4 patients, 3 patients had a phlebitis. Patients with a LST presented additional symtoms beside otalgia, i. e., dizziness, cephalgia, meningism, deafness of the affected ear, and facial nerve paresis. Postoperative MRI scans revealed a recanalization of the sinus in all cases. Although immediate surgery, 2 patients developed a 2-staged brain abscess in the cerebellum.

Conclusion: Clinical symptoms of the SVT are unspecific. In cases of an acute mastoiditis, neurological signs might be pathognomonic and can direct to a LST. Therapeutic concepts comprise intravenous antibiotics and operative elimination of disease. The exposition of the lateral sinus should be performed in any mastoidectomy for a LST in order to scrutinize its blood flow. In case of a thrombosis additional anticoagulative therapy might be indicated. To exclude a 2-staged brain abscess control MRI scans 7 through 14 days postoperatively are recommended.

Schlüsselwörter

Sinusvenenthrombose - Akute Mastoiditis - Cholesteatom - Therapie - Operation

Key words

lateral sinus thrombosis - acute mastoiditis - cholesteatoma - therapy

• Literatur

• 1 Miranda JA, Martins LL, Borges MH, Solcia Filho N, Mendes Ede A. Lateral sinus thrombosis and brain abscess as a complication of cholesteatoma. Braz J Otorhinolaryngol 2009; 75: 159-161
• 2 Bento R, de Brito R, Ribas GC. Surgical management of intracranial complications of otogenic infection. Ear Nose Throat J 2006; 85: 36-39
• 3 Balasubramanian A, Mohamad I, Sidek D. Extensive dural sinus thrombosis and bilateral lateral rectus palsy as an uncommon complication of chronic suppurative otitis media. BMJ Case Rep. 2013
• 4 Prasad SC, Shin SH, Russo A, Di Trapani G, Sanna M. Current trends in the management of the complications of chronic otitis media with cholesteatoma. Curr Opin Otolaryngol Head Neck Surg 2013; 21: 446-454
• 5 Navoa E, Podvinec M, Angst R, Gürtler N. Pediatric otogenic lateral sinus thrombosis: therapeutic management, outcome and thrombophilic evaluation. Int J Pediatr Otorhinolaryngol 2013; 77: 996-1001
• 6 Viswanatha B, Thriveni CN, Naseeruddin K. Nonseptic and septic lateral sinus thrombosis: a review. Indian J Otolaryngol Head Neck Surg 2014; 66 (Suppl. 01) 10-15
• 7 Kafadar I, Sözen ME, Büyüktas Aytac D, Yalcin K. Rare but threatening complication of otitis media: lateral sinus thrombosis. Pediatr Int 2014; 56: 918-920
• 8 Palma S, Bovo R, Benatti A, Aimoni C, Rosignoli M, Libanore M, Martini A. Mastoiditis in adults: a 19-year retrospective study. Eur Arch Otorhinolaryngol 2014; 271: 925-931
• 9 Viswanatha B. Lateral sinus thrombosis in children: a review. Ear Nose Throat J 2011; 90: E28-E33
• 10 Manolidis S, Kutz jr JW. Diagnosis and treatment of lateral sinus thrombosis. Otol Neurotol 2005; 26: 1045-1051
• 11 Hafidh MA, Keogh I, Walsh RM, Walsh M, Rawluk D. Otogenic intracranial complications. A 7-year retrospective review. Am J Otolaryngol 2006; 27: 390-395
• 12 De Oliveira Penido N, Testa JR, Inoue DP, Cruz OL. Presentation, treatment, and clinical course of otogenic lateral sinus thrombosis. Acta Otolaryngol 2009; 129: 729-734
• 13 Bielecki I, Cofala M, Mierzwinski J. Otogenic lateral sinus thrombosis in children. Otol Neurotol 2011; 32: 1111-1115
• 14 Au JK, Adam SI, Michaelides EM. Contemporary management of pediatric lateral sinus thrombosis: a twenty year review. Am J Otolaryngol 2013; 34: 145-150
• 15 Usuda K, Sakamaki M, Mokuno E, Karayama Y. A case of headache attributed to otitis media chronica cholesteatomica with cerebral sigmoid sinus thrombosis. J Nippon Med Sch 2008; 75: 340-343
• 16 Wang B, Peng C, Zhou MK, Guo J, He L. Clinical characteristics and prognosis of patients with cerebral venous sinus thrombosis in southwest China. Sichuan Da Xue Bao Yi Xue Ban 2014; 45: 515-518
• 17 Rosdy B, Csakanyi Z, Kollar K, Moser J, Mellar M, Kulcsar A, Kovacs E, Varallyay G, Katona G. Visual and neurologic deterioration in otogenic lateral sinus thrombosis: 15 year experience. Int J Pediatr Otorhinolaryngol 2014; 78: 1253-1257
• 18 Ghosh PS, Ghosh D, Goldfarb J, Sabella C. Lateral sinus thrombosis associated with mastoiditis and otitis media in children: a retrospective chart review and review of the literature. J Child Neurol 2011; 26: 1000-1004
• 19 Neilan RE, Isaacson B, Kutz Jr JW, Lee KH, Roland PS. Pediatric lateral sinus thrombosis recanalization. Int J Pediatr Otorhinolaryngol 2011; 75: 850-853
• 20 Quesnel S, Nguyen M, Pierrot S, Contencin P, Manach Y, Couloigner V. Acute mastoiditis in children: a retrospective study of 188 patients. Int J Pediatr Otorhinolaryngol 2010; 74: 1388-1392
• 21 Ropposch T, Nemetz U, Braun EM, Lackner A, Walch C. Low molecular weight heparin therapy in pediatric otogenic sigmoid sinus thrombosis: a safe treatment option?. Int J Pediatr Otorhinolaryngol 2012; 76: 1023-1026
• 22 Funamura JL, Nguyen AT, Diaz RC. Otogenic lateral sinus thrombosis: case series and controversies. Int J Pediatr Otorhinolaryngol 2014; 78: 866-870
• 23 Singh GB, Rai AK, Singh S, Sahu R, Arora R. Management of otogenic lateral sinus thrombosis. Auris Nasus Larynx 2014; 41: 143-147
• 24 Weimar C. Diagnosis and treatment of cerebral venous and sinus thrombosis. Curr Neurol Neurosci Rep 2014; 14: 417
• 25 Csakanyi Z, Rosdy B, Kollar K, Moser J, Kovacs E, Katona G. Timely recanalization of lateral sinus thrombosis in children: should we consider hypoplasia of contralateral sinuses in treatment planning?. Eur Arch Otorhinolaryngol 2013; 270: 1991-1998
• 26 Aguiar de Sousa D, Ferro JM, Canhao P, Barinagarrementeria Bousser MG, Stam J, Nogueira Pinto A, Viana Baptista M, Bejot Y, Dequatre-Ponchelle N. Cerebral venous thrombosis causing posterior fossa lesions: Description of a case series and assessment of safety of anticoagulation. Cerebrovasc Dis 2014; 38: 384-388
• 27 Sitton MS, Chun R. Pediatric otogenic lateral sinus thrombosis: role of anticoagulation and surgery. Int J Pediatr Otorhinolaryngol 2012; 76: 428-432