Complications of Cerebral Venous Thrombosis After Cerebellopontine Angle Tumor Resection: A STROBE Retrospective Observational Cohort Study.

Background and objectives: Postoperative cerebral venous thrombosis (pCVST) after skull base surgery remain a controversial topic in the literature, particularly considering their incidence, clinical course, association with postoperative complications, and potential need for anticoagulant therapy in the postoperative period.

Methods: We conducted a Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) retrospective observational study including all patients who underwent surgery for a cerebellopontine angle tumor between 2010 and 2023, with available postoperative imaging suitable for evaluating pCVST. Patients with cerebellar metastases were excluded. pCVSTs were categorized into 2 subgroups: severe venous stenosis and authentic thrombosis, based on imaging findings. A minimum follow-up of 12 months was required. The primary end point was the occurrence of postoperative complications, defined as death, hemorrhagic events, or cerebrospinal fluid leakage.

Results: A total of 158 patients were included, primarily with vestibular schwannomas (75%) and meningiomas (21%). pCVST was identified in 73 patients (46.2%), including 33 with severe stenosis and 40 with authentic thrombosis. Thrombosis was significantly associated with several surgical factors, such as sinus injury, venous compression, prolonged operative time, and transpetrous approaches. None of the patients newly received postoperative anticoagulant therapy in our study. Recanalization occurred in only 15.6% of cases with authentic thrombosis. Multivariate analysis showed no significant association between postoperative complications and the presence of thrombosis. However, the association with cerebrospinal fluid leakage approached significance in univariate analysis (P = .07).

Conclusion: Postoperative venous thrombosis is not an uncommon finding after cerebellopontine angle tumor surgery. Our results do not support a significant association with major postoperative complications nor evidence to support the routine use of anticoagulation, given the potential for hemorrhagic complications and the uncertain therapeutic benefit.