Background and aims
Otogenic cerebral venous sinus thrombosis (OCVST) is a rare complication of otitis media and mastoiditis, developing in an estimated 0–3% of cases, with a mortality rate of 5–10%. Despite widespread use of anticoagulation, no consensus exists on optimal treatment duration or how interval imaging should guide management. We aimed to determine whether the radiological extent of thrombosis predicts anticoagulation duration, and to define an appropriate timeframe for follow-up MRI.
Methods
We retrospectively reviewed seven years of paediatric OCVST cases presenting to Alder Hey Children's Hospital, UK. Demographic, clinical, radiological and laboratory data were collected. Patients were stratified by thrombosis extent: single sinus involvement, multi-sinus involvement without internal jugular vein (IJV) thrombosis, and multi-sinus involvement with IJV thrombosis. Interval MRI findings were correlated with anticoagulation duration.
Results
Seventeen children were included (mean age 3.7 years; 82% male). All underwent contrast-enhanced CT and MRI/MRV. Complete recanalisation occurred by four months in all single-sinus cases (n=4). Among multi-sinus cases without IJV involvement (n=8), complete recanalisation was uncommon; collateral-dependent or partial recanalisation predominated (62.5%). Outcomes were similar in IJV-involved cases (n=5). All patients received anticoagulation for a median of six months, regardless of thrombosis extent or radiological resolution.
Conclusion
Anticoagulation duration appeared driven more by radiological stability and collateral circulation than by initial thrombosis extent. We propose a standardised, haematology-informed pathway defining anticoagulation duration and optimal timing of follow-up MRI — bringing clarity to a condition where guidance has long been lacking.