The role of decompressive craniectomy in cerebral venous sinus thrombosis

Clinical article

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Object

Studies on the role of decompressive craniectomy for cerebral venous sinus thrombosis (CVST) in the literature are scanty. Randomized trials face a lot of drawbacks, including ethical issues. In this article the authors discuss their experience with this procedure for CVST and review the available literature.

Methods

This study was a retrospective analysis of all patients who underwent decompressive craniectomy for CVST between August 2006 and June 2008 at the National Institute of Mental Health and Neurosciences. The cases were evaluated for demographic and clinicoradiological features, operative findings, and outcome of surgery. Ethical clearance was obtained from the institutional ethics committee. The data for each patient were obtained from the database of the department. Follow-up data were obtained either through direct clinical evaluation or mailed self-report questionnaire. The Glasgow Outcome Scale (GOS) and the Rankin Disability Scale were used to assess the outcome.

Results

A total of 34 patients (13 men and 21 women) were included; their mean age was 31.6 years, with a range from 18 to 65 years. In univariate analysis, the Glasgow Coma Scale (GCS) score prior to surgery and that in the immediate postoperative period had a statistically significant correlation with poor outcome. The GCS score immediately postoperatively was the only independent, significant predictor of poor outcome on multivariate analysis.

Conclusions

Decompressive craniectomy in a selected cohort of patients had a good outcome in a majority of the patients: 26 of 34 in this study had a GOS score of 4 or 5. In this series, which is the largest in the available literature, the authors review their experience and recommend usage of this procedure in selected patients.

Abbreviations used in this paper:CVST = cerebral venous sinus thrombosis; GCS = Glasgow Coma Scale; GOS = Glasgow Outcome Scale; ICH = intracerebral hemorrhage; ICP = intracranial pressure; ISCVT = International Study on Cerebral Vein and Dural Sinus Thrombosis; RDS = Rankin Disability Scale.

Article Information

Address correspondence to: Sampath Somanna, M.Ch., Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bangalore—560029, Karnataka, India. email: dwarakaneuro@yahoo.com.

Please include this information when citing this paper: published online August 24, 2012; DOI: 10.3171/2012.6.JNS11102.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Plain head CT scan showing a hemorrhagic infarct in the right frontal lobe secondary to sagittal sinus thrombosis. Also note the midline shift and perilesional edema.

  • View in gallery

    Plain head CT scan obtained in the immediate postoperative period (10 days later) showing partial resolution of the hemorrhage along with the decrease in the midline shift.

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