Pediatric lateral sinus thrombosis: retrospective case series and literature review.

OBJECTIVE

A comparison between the literature and our management of pediatric patients presenting with otogenic lateral sinus thrombosis.

DESIGN

A retrospective case series of five pediatric patients.

SETTING

Four patients were treated at BC Children's Hospital, whereas the fifth patient was treated in New Westminster, BC. All were treated between 1994 and 2001.

METHODS

A retrospective chart review was conducted with a literature review for otogenic lateral sinus thrombosis.

MAIN OUTCOME MEASURES: Treatment success was based on resolution of acute infection and neurologic symptoms.

RESULTS

Five patients, four males and one female, aged 2 to 14 years were reviewed. Three patients were treated successfully without mastoidectomy. One patient received a mastoidectomy that yielded no pus or granulation tissue within the mastoid cavity. One patient required a mastoidectomy after failure to respond to bilateral myringotomy and tympanostomy tube insertion. Although no pus was seen in the mastoid cavity, perisinus pus was found after unroofing the sigmoid sinus plate; free flow of blood was obtained on needle aspiration of the sinus, and the sinus was not surgically opened.

CONCLUSION

The current literature states that the management of otogenic lateral sinus thrombosis includes high-dose intravenous antibiotics with a mastoidectomy and possible opening of the sinus. In our retrospective case series, three of five patients recovered completely without mastoidectomy, and a fourth had a mastoidectomy deemed to have been unnecessary. We conclude that intravenous antibiotics and insertion of a tympanostomy tube are sufficient treatment for selected cases of otogenic lateral sinus thrombosis. Mastoidectomy with possible opening of the sinus should be reserved for patients refractory to the above conservative treatment.