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Laryngorhinootologie 2016; 95(01): 37-42
DOI: 10.1055/s-0035-1555914
Originalie
© Georg Thieme Verlag KG Stuttgart · New York

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

Lateral Sinus Thrombosis – A Rare Complication of an Acute Mastoiditis or Infected Cholesteatoma
S. K. Graß
1   Klinikum Nordstadt, Klinik für HNO-Heilkunde, regionale plastische Chirurgie, Kopf- und Halschirurgie, Hannover
,
H.-J. Welkoborsky
1   Klinikum Nordstadt, Klinik für HNO-Heilkunde, regionale plastische Chirurgie, Kopf- und Halschirurgie, Hannover
,
C. Bersch
2   Institut für Pathologie, Klinikum Nordstadt, Hannover
› Author Affiliations
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Publication History

eingereicht 02 April 2015

akzeptiert 03 July 2015

Publication Date:
15 October 2015 (online)

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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
 

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