Cerebral venous sinus thrombosis during superselective intra-arterial infusion of cisplatin and concomitant radiotherapy for maxillary squamous cell carcinoma

Description

A 67-year-old man was referred to our department because of epistaxis. CT demonstrated that a mass had destroyed the posterior bony wall of the left paranasal sinus. Histopathological examination revealed squamous cell carcinoma of the maxillary sinus, and clinically staged T4aN0M0 was diagnosed. MRI showed no thrombus in the brain blood vessels.

The initially planned treatment consisted of seven courses of intra-arterial infusion (IA) of weekly cisplatin (100 mg/m²) with intravenous detoxification by sodium thiosulfate and concomitant radiotherapy (RT) (total 70 Gy).1 CT angiography revealed that the maxillary and facial arteries were feeding the tumour. After four courses of IA, MRI and CT (figure 1A) were performed for an interim evaluation. Although the size of the tumour was significantly reduced, cerebral venous thrombus was present in the left transverse sigmoid sinus and interrupted the blood flow without cortical venous reflux or brain oedema (

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