Incidence of Dural Venous Sinus Thrombosis in Patients with Glioblastoma and Its Implications.
OBJECTIVE
Glioblastoma (GBM) is associated with increased risk of developing dural venous sinus thrombosis (DVST), which often goes undiagnosed as symptoms are readily attributed to tumor. The purpose of this study was to investigate the incidence of DVST, potential predictive features on imaging, complications, its effect on survival, and time of greatest risk for developing DVST.


METHODS
A retrospective search of patients with GBM who had surgery followed by chemotherapy and/or radiation therapy between 2009 and 2015 at our institution was performed. Magnetic resonance imaging studies of the brain were reviewed on volumetric postgadolinium T1-weighted sequences for DVST. Tumors were characterized using the Visually Accessible REMBRANDT (Repository for Molecular Brain Neoplasia Data) Images classification, and identified thromboses were tracked for propagation, regression, or resolution. Statistical analyses were directed at identifying clinical predictors and survival differences between the DVST and no-DVST groups.


RESULTS
In total, 163 cases totaling 1637 scans, were reviewed; 12 patients (7.4%) developed DVST, of whom 11 presented with thrombus before any treatment. Tumor invasion of dural sinuses and greater T1/fluid-attenuated inversion recovery ratios were significantly associated with thrombus development (P = 0.02 and P = 0.02, respectively). In patients who developed DVST, thrombosis was more likely to develop ipsilateral to tumor side (P = 0.01) and was associated with a greater likelihood of developing extracranial venous thromboembolism (P = 0.012). There were no venous infarcts and no significant difference in survival between groups (P = 0.83).


CONCLUSIONS
Patients with GBM have increased risk of developing DVST, independent of surgical treatment or chemoradiation. DVST presence does not affect survival. Tumor invasion of dural sinuses and greater T1/fluid-attenuated inversion recovery ratio on preoperative imaging were the most significant predictors of DVST development.
['Helmi|Ali|A|', 'Chan|Aimee|A|', 'Towfighi|Sohrab|S|', 'Kapadia|Anish|A|', 'Perry|James|J|', 'Ironside|Sarah|S|', 'Machnowska|Matylda|M|', 'Symons|Sean P|SP|', 'Fox|Allan J|AJ|', 'Sahgal|Arjun|A|', 'Maralani|Pejman Jabehdar|PJ|']
D001932:Brain Neoplasms D016022:Case-Control Studies D003392:Cranial Sinuses D005260:Female D005909:Glioblastoma D006801:Humans D018810:Magnetic Resonance Angiography D008297:Male D008875:Middle Aged D009361:Neoplasm Invasiveness D012189:Retrospective Studies D012851:Sinus Thrombosis, Intracranial D016896:Treatment Outcome
Dural venous sinus thrombosis Glioblastoma Magnetic resonance imaging VASARI