Dural Venous Sinus Thrombosis in Patients Presenting with Blunt Traumatic Brain Injuries and Skull Fractures: A Systematic Review and Meta-analysis.

ABSTRACT Introduction Dural venous sinus thrombosis (DVST) is an increasingly recognized complication of blunt traumatic brain injury (TBI) and skull fractures. However, data concerning the epidemiology and clinical significance of this entity is unclear. Determining the disease burden in the TBI population is an important first step to guide future studies assessing the natural course of traumatic DVST or the effects of its treatment. We therefore set out to perform the first systematic review and meta-analysis evaluating the prevalence of DVST in TBI patients with fractures. Materials and Methods MEDLINE and EMBASE databases were systematically searched for relevant studies published up to March 2018. We included all studies that assessed the prevalence of DVST among TBI patients and underwent a vascular imaging study. The primary outcome was the presence or absence of DVST on imaging. A random effects meta-analysis was used to pool studies. Results Our systematic review yielded 638 articles and a total of 13 articles met inclusion criteria. In patients with skull fractures adjacent to a venous sinus, the prevalence was found to be 26.2% (95% confidence interval (CI) = 19.4% - 34.4%). This elevated risk was similar between adult (pooled estimate 23.8%; 95% CI = 16.2% - 33.5%) and pediatric populations (pooled estimate 31.3%; 95% CI = 19.1% - 46.9%). Conclusions We show an unexpectedly high and consistent frequency of DVST among patients with skull fractures regardless of age group or severity of brain injury. These findings are important and highlight the need for further understanding the natural history of this entity and providing better guidelines on its management.