Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 26, 2020; 8(6): 1158-1163
Published online Mar 26, 2020. doi: 10.12998/wjcc.v8.i6.1158
Cerebral venous sinus thrombosis following transsphenoidal surgery for craniopharyngioma: A case report
Tao Chang, Yan-Long Yang, Li Gao, Li-Hong Li
Tao Chang, Yan-Long Yang, Li-Hong Li, Department of Emergency Medicine, Second Affiliated Hospital of Air Force Medical University, Xi’an 710038, Shaanxi Province, China
Li Gao, Department of Neurosurgery, Second Affiliated Hospital of Air Force Medical University, Xi’an 710038, Shaanxi Province, China
Author contributions: Chang T and Li LH performed the diagnostic investigations and treatments; Chang T and Yang YL reviewed the literature and contributed to manuscript drafting; Gao L was the patient’s neurosurgeon; Li LH was responsible for the revision of the manuscript for important intellectual content; all authors issued final approval for the version to be submitted.
Informed consent statement: Written informed consent was obtained from the patient’s kin for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that there is no conflict of interest regarding the publication of this manuscript.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Li-Hong Li, MD, Assistant Professor, Doctor, Department of Emergency Medicine, Second Affiliated Hospital of Air Force Medical University, No. 1, Xinsi Road, Xi’an 710038, Shaanxi Province, China. llh13892860126@yeah.net
Received: December 21, 2019
Peer-review started: December 21, 2019
First decision: February 20, 2020
Revised: March 10, 2020
Accepted: March 14, 2020
Article in press: March 14, 2020
Published online: March 26, 2020
Abstract
BACKGROUND

Cerebral venous sinus thrombosis (CVST) is a rare condition in patients with craniopharyngioma following transsphenoidal surgery.

CASE SUMMARY

A 56-year-old man who underwent transsphenoidal surgery for craniopharyngioma 26 d ago presented gradual headache and cerebrospinal fluid leakage while vomiting 5 d post-discharge and required readmission to our department of neurosurgery. After admission, head imaging examination showed a hyperdense shadow in the superior sagittal sinus and right transverse sinus, edema at the bilateral parietal lobe, and hemorrhage at the left parietal lobe and right occipital lobe; the venous phase of cerebral angiography revealed CVST. The patient was treated immediately by intravenous thrombolysis, endovascular thrombolysis, and mechanical thrombectomy after the definite diagnosis. However, the neurological status of the patient continued to deteriorate and he died on the fourth day after readmission.

CONCLUSION

For craniopharyngioma undergoing transsphenoidal surgery, it is vital to take an effective strategy to manage the postoperative complications, such as diabetes insipidus, severe electrolyte imbalance, and cerebrospinal fluid leakage. Additionally, the early differential diagnosis of CVST is essential when it develops clinical symptoms, especially in patients following transsphenoidal surgery with a high risk of CVST. Subsequently, the timely and effective treatment of the CVST is critical for preventing neurological deterioration.

Keywords: Craniopharyngioma, Transsphenoidal surgery, Cerebral venous sinus thrombosis, Case report

Core tip: Cerebral venous sinus thrombosis (CVST) is a rare condition in patients with craniopharyngioma following transsphenoidal surgery. This case highlights that there may be a significant relationship between systemic hypovolemia, cerebrospinal fluid leakage, gene mutation, and CVST formation. The early differential diagnosis of CVST is essential when it develops clinical symptoms, especially in patients following transsphenoidal surgery with a high risk of CVST. Additionally, the timely and effective treatment of the CVST is critical for preventing neurological deterioration.