Risk Factors for and Rate of Development of Venous Thromboembolism in Lateral Skull Base Surgery

Introduction: Venous thromboembolism (VTE), which comprises deep vein thrombosis (DVT) and pulmonary embolism (PE), is a major cause of morbidity and mortality for surgical patients. Rates of DVT formation in the neurosurgical patient are high, reaching anywhere from 15 to 30%. However, this does not appear to be true for patients undergoing lateral skull base surgery for vestibular schwannoma, with postsurgical DVT rates of 0 to 3.2%. This brings into questions the need for chemoprophylaxis versus mechanical prophylaxis alone for DVT prevention. There is no definitive consensus on DVT prophylaxis in neurosurgical patients as the risk of hemorrhagic complications could lead to catastrophic morbidity or mortality. The aim of this paper is to determine factors that may contribute to the development of venous thromboembolism in patients undergoing lateral skull base surgery and to determine the efficacy of mechanical DVT prophylaxis alone in preventing VTE.

Methods: A retrospective chart review was conducted of patients admitted to the intensive care unit (ICU) after elective lateral skull base surgery for vestibular schwannoma at a single institution. These patients underwent excision via a standard translabyrinthine, retrosigmoid, or middle cranial fossa approach. Patient demographics, comorbidities, and postoperative DVT prophylaxis methods were examined to determine risk factors that may be associated with the development of a postoperative, radiographically evident, thrombotic event within 6 months after surgery. The rate of VTE formation was also determined in this patient population.

Results: Seven patients developed a postoperative thrombotic event. Six developed a DVT or PE and one developed a sigmoid and lateral sinus thrombosis. There were no significant risk factors in regards to demographics or comorbidities that contributed to the development of a thrombotic event ([Fig. 1]). One hundred and eighty (91.8%) patients used a sequential compression device alone for DVT prophylaxis. Of the seven patients who developed a thrombotic event, all used a sequential compression device (SCD) alone for DVT prophylaxis; however, this was not significant. The rate of DVT formation in this population was 3.0%, which is consistent with other literature that looked at DVT formation in patients undergoing lateral skull base surgery for vestibular schwannomas.

Conclusion: There does not appear to be any significant risk factor with regards to age, gender, comorbidities or ASA score that are associated with the development of a thrombotic event. Given the apparent low risk of VTE in patients undergoing lateral skull base surgery for vestibular schwannoma, in conjunction with current guidelines, it seems reasonable that mechanical prophylaxis is sufficient for VTE prophylaxis and minimizes the risk of developing a catastrophic postoperative hemorrhagic event.

Publication History

Article published online:
12 February 2021