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Fulminant intracranial hypertension as a result of otological surgery: case report and discussion of management

Published online by Cambridge University Press:  18 May 2021

A Morris ,
J N Higgins  and
P R Axon
A Morris
Affiliation:
School of Clinical Medicine, Addenbrooke's Hospital, Cambridge, UK
J N Higgins
Affiliation:
Department of Radiology, Addenbrooke's Hospital, Cambridge, UK
P R Axon*
Affiliation:
Cambridge Skull Base Unit, Addenbrooke's Hospital, Cambridge, UK
*
Author for correspondence: Mr Patrick R Axon, Cambridge Skull Base Unit, Addenbrooke's Hospital, Hills Road, CambridgeCB2 0QQ, UK E-mail: praxon@talk21.com
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Abstract

Background

Dural venous sinus injury is a rare complication of otological surgery that can lead to life-threatening sequelae, the management of which is complex and poorly described.

Case report

This paper describes the case of a 40-year-old female who underwent routine right myringoplasty complicated by sigmoid sinus laceration. The patient subsequently developed right-sided lateral sinus thrombosis leading to fulminant intracranial hypertension. The patient underwent successful emergency management by surgical reconstruction of the sigmoid sinus, followed by endovascular thrombolysis, catheter balloon angioplasty and endovascular stenting.

Conclusion

Torrential haemorrhage following otological procedures is uncommon and rarely requires packing of a bleeding venous sinus. This case highlights that injury to a highly dominant venous sinus can lead to venous outflow obstruction and life-threatening intracranial hypertension. To our knowledge, the development of this complication following otological surgery and its management has not been reported previously.

Keywords

Lateral Sinus ThrombosisMyringoplastyIntracranial HypertensionBalloon AngioplastyThrombolytic Therapy
Type
Clinical Records
Information
The Journal of Laryngology & Otology , Volume 135 , Issue 6 , June 2021 , pp. 551 - 554
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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Footnotes

Mr P R Axon takes responsibility for the integrity of the content of the paper

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