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Research paper
Decompressive craniectomy in cerebral venous thrombosis: a single centre experience
  1. Sanjith Aaron1,
  2. Mathew Alexander1,
  3. Ranjith K Moorthy1,
  4. Sunithi Mani2,
  5. Vivek Mathew1,
  6. Anil Kumar B Patil1,
  7. Ajith Sivadasan1,
  8. Shalini Nair3,
  9. Mathew Joseph3,
  10. Maya Thomas1,
  11. Krishna Prabhu4,
  12. Baylis Vivek Joseph4,
  13. Vedantam Rajshekhar4,
  14. Ari George Chacko4
  1. 1Neurology Unit, Department of Neurological Sciences, Christian Medical College & Hospital, Vellore, Tamil Nadu, India
  2. 2Department of Radiology, Christian Medical College & Hospital, Vellore, Tamil Nadu, India
  3. 3Neurocritical Care Unit, Department of Neurological Sciences, Christian Medical College & Hospital, Vellore, Tamil Nadu, India
  4. 4Neurosurgery Unit, Department of Neurological Sciences, Christian Medical College & Hospital, Vellore, Tamil Nadu, India
  1. Correspondence to Dr Mathew Alexander, Neurology Unit, Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu 632004, India; mathewalex{at}cmcvellore.ac.in

Abstract

Background Cerebral venous thrombosis (CVT) is an important cause for stroke in the young where the role for decompressive craniectomy is not well established.

Objective To analyse the outcome of CVT patients treated with decompressive craniectomy.

Methods Clinical and imaging features, preoperative findings and long-term outcome of patients with CVT who underwent decompressive craniectomy were analysed.

Results Over 10 years (2002–2011), 44/587 (7.4%) patients with CVT underwent decompressive craniectomy. Diagnosis of CVT was based on magnetic resonance venography (MRV)/inferior vena cava (IVC). Decision for surgery was taken at admission in 19/44 (43%), within 12 h in 5/44 (11%), within first 48 h in 15/44 (34%) and beyond 48 h in 10/44 (22%). Presence of midline shift of ≥10 mm (p<0.0009) and large infarct volume (mean 146.63 ml; SD 52.459, p<0.001) on the baseline scan influenced the decision for immediate surgery. Hemicraniectomy was done in 38/44 (86%) and bifrontal craniectomy in 6/44 (13.6%). Mortality was 9/44 (20%). On multivariate analysis (5% level of significance) age <40 years and surgery within 12 h significantly increased survival. Mean follow-up was 25.5 months (range 3–66 months), 26/35 (74%) had 1 year follow-up. Modified Rankin Scale (mRs) continued to improve even after 6 months with 27/35 (77%) of survivors achieving mRs of ≤2.

Conclusions This is the largest series on decompressive craniectomy for CVT in literature to date. Decompressive craniotomy should be considered as a treatment option in large venous infarcts. Very good outcomes can be expected especially if done early and in those below 40 years.

  • Sinus thrombosis
  • Surgery

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