Treatment of sigmoid sinus thrombosis with long-term anticoagulation therapy remains controversial. We pre-sent the case of a 6-year-old boy with intraoperatively confirmed sigmoid sinus thrombosis secondary to acute otomastoiditis. Combined-modality treatment-including mastoidectomy, sigmoid sinus decompression, and antibiotic and anticoagulation therapy-resulted in a complete clinical resolution of the patient's signs and symptoms. However, a 19-month follow-up with magnetic resonance venography demonstrated that the sigmoid sinus thrombosis itself had not resolved. It is clear that occlusion of the sigmoid sinus may persist after the completion of surgical and medical therapy for sigmoid sinus thrombosis secondary to otomastoiditis. It remains unclear (1) whether anticoagulation treatment aids in recanalization of the affected sinus and (2) whether patient outcomes are affected if recanalization is achieved.