The role of anticoagulation in the management of pediatric temporal bone septic thrombophlebitis.

BACKGROUND Lateral dural venous sinus thrombosis (LST) represents a serious complication of acute or chronic otitis media. It is thought to develop from the progression of inflammation and granulation tissue formation in the perisinus bone to infection of the sinus wall proper, with incitement of mural thrombosis. Treatment of LST typically includes the administration of broad-spectrum parenteral antibiotics and surgical decompression of the middle ear and/or mastoid. The safety and efficacy of anticoagulation in the management of LST remains controversial. Proponents of anticoagulation argue that this treatment enhances the resolution of symptoms, helps reestablish sinus patency, and reduces intracranial pressure in cases of otitic hydrocephalus. However, others argue that anticoagulation carries serious risks without definitive benefit. This best practice review addresses three interrelated issues of anticoagulation for LST: 1) is anticoagulation safe in patients with LST; 2) does anticoagulation impact the likelihood of dural venous sinus recanalization; and 3) does anticoagulation impact the likelihood of long-term symptom resolution.