Cerebral Venous Sinus Thrombosis Risk in Inflammatory Bowel Disease Patients Undergoing Neurosurgery: A Comprehensive Review and Evidence-Based Perioperative Management Guidelines

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Published Jan 28, 2026
DOI: https://doi.org/10.18103/mra.v14i1.7213

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Main Article Content

Kentaro Watanabe, MD, PhD
Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan
Ande Fachniadin, MD
Department of Neurosurgery, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Indonesia
Nobuyuki Watanabe, MD, PhD
Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan
Kohei Ishikawa, MD
Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan
Kyoichi Tomoto, MD
Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan; Department of Neurosurgery, Kameda General hospital, Chiba, Japan
Yuichi Murayama, MD, PhD
Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan

Abstract

Background: Patients with inflammatory bowel disease (IBD) face a three-fold higher risk of venous thromboembolism than healthy individuals. Traditional prevention strategies focus on active disease flares. However, a recent fatal case from our institution—superior sagittal sinus thrombosis occurring three weeks after microvascular decompression in a patient with quiescent ulcerative colitis—suggests that surgical stress itself may be the dominant risk factor, independent of bowel disease activity.


Methods: We searched Semantic Scholar and OpenAlex databases for published cases of cerebral venous sinus thrombosis in inflammatory bowel disease patients with surgical triggers. From 500 initial publications, we analyzed 22 individual case reports and one systematic review of 35 patients. We extracted data on disease characteristics, surgical procedures, thrombosis timing, and outcomes. Based on these findings and international guidelines, we developed a surgical risk classification system and corresponding perioperative management protocol.


Results: Ulcerative colitis accounted for 79% of cases, showing 3.8-fold higher prevalence than Crohn's disease. Critically, 26.3% of thrombotic events occurred during documented clinical remission. The superior sagittal sinus was involved in 52.6% of cases, with 10.5% mortality. Surgical intervention preceded thrombosis in 84.2% of cases, with most events (68.4%) occurring 2-4 weeks postoperatively. Neurosurgical procedures posed the highest risk through cerebrospinal fluid dynamics disruption.


Conclusion: Surgical invasiveness drives cerebral venous sinus thrombosis risk regardless of inflammatory bowel disease activity status. The delayed vulnerability window (2-4 weeks post-surgery) necessitates extended prophylaxis protocols and structured monitoring for high-risk procedures, particularly neurosurgery.

Keywords: Cerebral venous sinus thrombosis, Inflammatory bowel disease, Neurosurgery, Perioperative management, Risk stratification, Thromboprophylaxis

Article Details

How to Cite
WATANABE, Kentaro et al. Cerebral Venous Sinus Thrombosis Risk in Inflammatory Bowel Disease Patients Undergoing Neurosurgery: A Comprehensive Review and Evidence-Based Perioperative Management Guidelines. Medical Research Archives, [S.l.], v. 14, n. 1, jan. 2026. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/7213>. Date accessed: 03 feb. 2026. doi: https://doi.org/10.18103/mra.v14i1.7213.
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Issue
Vol 14 No 1 (2026): Vol.14, Issue 1, January 2026
Section
Review Articles

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Footnotes:
¹ Total Risk Score calculation: Procedure Category Score (Category A: 4-5 points, Category B-C: 3-4 points, Category D: 2-3 points) plus Patient Modifying Factors (1 point each: age ≥60 years, prior thrombosis, corticosteroid exposure within 30 days, expected NPO >48 hours, estimated blood loss >500mL, postoperative immobility >24 hours, anemia, central venous catheter, active extraintestinal IBD manifestations)
² Prophylaxis protocols: Standard = LMWH during hospitalization; Enhanced = standard plus 2-week post-discharge DOAC (rivaroxaban 10mg daily or apixaban 2.5mg BID); Intensive = standard plus 4-week post-discharge DOAC. For neurosurgical procedures, delay pharmacological prophylaxis until hemostasis confirmed
³ D-dimer escalation threshold: >50% increase from baseline or >2× upper limit of normal warrants urgent neurological evaluation and imaging
⁴ Duration modifications: Extend to 6 weeks for Category A (neurosurgical) procedures when bleeding risk is acceptable; individualize based on patient-specific factors
⁵ Follow-up structure: Weekly appointments include structured symptom assessment, hydration counseling, medication adherence review, and low-threshold escalation protocols for neurological symptoms