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.