The role of decompressive craniectomy in cerebral venous sinus thrombosis

Clinical article

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  • 1 Departments of Neurosurgery and
  • | 2 Neurology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
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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.

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  • 1

    Bousser MG, & Ferro JM: Cerebral venous thrombosis: an update. Lancet Neurol 6:162170, 2007

  • 2

    Breteau G, , Mounier-Vehier F, , Godefroy O, , Gauvrit JY, , Mackowiak-Cordoliani MA, & Girot M, et al.: Cerebral venous thrombosis 3-year clinical outcome in 55 consecutive patients. J Neurol 250:2935, 2003

    • Search Google Scholar
    • Export Citation
  • 3

    Bugnicourt JM, , Roussel-Pieronne M, , Dupuy-Sonntag D, , Canaple S, & Godefroy O: [Cerebral venous thrombosis: long-term functional and cognitive outcome in 16 patients.]. Rev Neurol (Paris) 164:131137, 2008. (Fr)

    • Search Google Scholar
    • Export Citation
  • 4

    Cakmak S, , Derex L, , Berruyer M, , Nighoghossian N, , Philippeau F, & Adeleine P, et al.: Cerebral venous thrombosis: clinical outcome and systematic screening of prothrombotic factors. Neurology 60:11751178, 2003

    • Search Google Scholar
    • Export Citation
  • 5

    Canhão P, , Ferro JM, , Lindgren AG, , Bousser MG, , Stam J, & Barinagarrementeria F: Causes and predictors of death in cerebral venous thrombosis. Stroke 36:17201725, 2005

    • Search Google Scholar
    • Export Citation
  • 6

    Caso V, , Billeci AM, & Leys D: Interventional neuroradiology in the treatment of cerebral venous thrombosis. Front Neurol Neurosci 23:144160, 2008

    • Search Google Scholar
    • Export Citation
  • 7

    Coutinho JM, , Majoie CB, , Coert BA, & Stam J: Decompressive hemicraniectomy in cerebral sinus thrombosis: consecutive case series and review of the literature. Stroke 40:22332235, 2009

    • Search Google Scholar
    • Export Citation
  • 8

    Crassard I, & Bousser MG: Cerebral venous thrombosis. J Neuroophthalmol 24:156163, 2004

  • 9

    de Bruijn SF, , de Haan RJ, & Stam J: Clinical features and prognostic factors of cerebral venous sinus thrombosis in a prospective series of 59 patients. J Neurol Neurosurg Psychiatry 70:105108, 2001

    • Search Google Scholar
    • Export Citation
  • 10

    Ferro JM, , Canhão P, , Stam J, , Bousser MG, & Barinagarrementeria F: Prognosis of cerebral vein and dural sinus thrombosis: results of the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT). Stroke 35:664670, 2004

    • Search Google Scholar
    • Export Citation
  • 11

    Ferro JM, , Lopes MG, , Rosas MJ, , Ferro MA, & Fontes J: Cerebral Venous Thrombosis Portugese Collaborative Study Group: Long-term prognosis of cerebral vein and dural sinus thrombosis. results of the VENOPORT study. Cerebrovasc Dis 13:272278, 2002

    • Search Google Scholar
    • Export Citation
  • 12

    Girot M, , Ferro JM, , Canhão P, , Stam J, , Bousser MG, & Barinagarrementeria F, et al.: Predictors of outcome in patients with cerebral venous thrombosis and intracerebral hemorrhage. Stroke 38:337342, 2007

    • Search Google Scholar
    • Export Citation
  • 13

    Keller E, , Pangalu A, , Fandino J, , Könü D, & Yonekawa Y: Decompressive craniectomy in severe cerebral venous and dural sinus thrombosis. Acta Neurochir Suppl 94:177183, 2005

    • Search Google Scholar
    • Export Citation
  • 14

    Masdeu JC, , Irimia P, , Asenbaum S, , Bogousslavsky J, , Brainin M, & Chabriat H, et al.: EFNS guideline on neuroimaging in acute stroke. Report of an EFNS task force. Eur J Neurol 13:12711283, 2006

    • Search Google Scholar
    • Export Citation
  • 15

    Nagaraja D, , Haridas T, , Taly AB, , Veerendrakumar M, & SubbuKrishna DK: Puerperal cerebral venous thrombosis: therapeutic benefit of low dose heparin. Neurol India 47:4346, 1999

    • Search Google Scholar
    • Export Citation
  • 16

    Preter M, , Tzourio C, , Ameri A, & Bousser MG: Long-term prognosis in cerebral venous thrombosis. Follow-up of 77 patients. Stroke 27:243246, 1996

    • Search Google Scholar
    • Export Citation
  • 17

    Rondepierre P, , Hamon M, , Leys D, , Leclerc X, , Mounier-Vehier F, & Godefroy O, et al.: [Cerebral venous thromboses: study of the course.]. Rev Neurol (Paris) 151:100104, 1995. (Fr)

    • Search Google Scholar
    • Export Citation
  • 18

    Stefini R, , Latronico N, , Cornali C, , Rasulo F, & Bollati A: Emergent decompressive craniectomy in patients with fixed dilated pupils due to cerebral venous and dural sinus thrombosis: report of three cases. Neurosurgery 45:626630, 1999

    • Search Google Scholar
    • Export Citation

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