An Update on the Management of Otogenic Cerebral Sinus Thrombosis: A Systematic Review.

INTRODUCTION

Otogenic cerebral sinus thrombosis (OCST) represents a rare but serious pathology. The medical and surgical treatment to achieve optimal patient outcomes remains unclear. This review assesses the published evidence of OCST to guide best practice.

METHODS

A search of electronic databases Medline, Embase, Emacare, Cochrane and Clinicaltrials.gov was conducted from inception to November 2024. Eligible studies were identified and relevant findings extracted.

RESULTS

Sixty-eight papers, 43 case reports and 25 case series met the inclusion criteria with a total of 149 patients. 88.5% of patients underwent surgery, most commonly cortical mastoidectomy. 54.8% of patients received anticoagulation. Sixty-five percent of patients with reimaging had complete recannalisation of the sinus and 9.4% of patients experienced long term complications.

CONCLUSIONS

The combination of antibiotics, anticoagulation and surgery was associated with the most favourable outcome. Mastoidectomy and decompression of the sigmoid were commonly performed and largely safe. However, no additional benefit of incision and drainage of the sigmoid sinus was found and this was associated with a higher complication rate.