Lateral sinus thrombosis: A review of seven cases and proposal of a management algorithm

Objective: To evaluate the demographics, diagnosis, management, and outcomes of lateral sinus thrombosis in a pediatric population, and to propose a new treatment algorithm. Methods: Retrospective review of seven patients. Results: Patients averaged 7.4 years of age. They commonly presented with headache and otalgia (seven of seven patients), and nausea and vomiting (six of seven patients). All patients had abnormal otoscopy, and four of seven patients had a lateral rectus palsy, but fever was not always present (only three of seven patients). All patients underwent MRI with venography (MRV) for diagnosis. All patients were admitted to the hospital (average length of stay 8 days) and treated with antibiotics (six of seven patients with IV ceftriaxone). Five of seven were treated with simple mastoidectomy and concurrent middle ear ventilation tubes; two patients received only medical treatment. The average follow up was 114 months (range 33-387 months). Two patients had long-term sequela: one had persistent mild lateral gaze diplopia and another had unilateral moderate to severe high frequency sensorineural hearing loss. Six of seven patients had follow up imaging (average 15 months, range 1-40 months). Four of six patients showed recanalization of the lateral sinus on repeat imaging. Based on the current experience in the modern era of MRV and broad-spectrum antibiotics, a new treatment algorithm is proposed. Conclusions: Lateral sinus thrombosis is an uncommon cranial complication of otitis media. The advent of non-invasive diagnosis and effective broad-spectrum antibiotics has drastically decreased the mortality and altered the diagnostic and treatment paradigm. (C) 2008 Elsevier Ireland Ltd. All rights reserved.