Decompressive craniectomy in cerebral venous thrombosis: a single centre experience

Aaron, Sanjith; Alexander, Mathew; Moorthy, Ranjith K; Mani, Sunithi; Mathew, Vivek; Patil, Anil Kumar; Sivadasan, Ajith; Nair, Shalini; Joseph, Mathew; Thomas, Maya; Prabhu, Krishna; Joseph, Baylis Vivek; Rajshekhar, Vedantam; Chacko, Ari G

doi:10.1136/jnnp-2012-303356

Cited by 74 publications

(68 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…There appears to be no role for deciding the length of anticoagulation based on recanalisation because this only occurs during the first few months after CVT, and no correlation has been found between recanalisation and clinical outcome. 30 Finally, it is worth mentioning direct oral anticoagulants (DOACs). Studies have shown that DOACs are no less effective than warfarin in both the treatment of VTE and prevention of recurrence.…”

Section: Management Of Cvtmentioning

confidence: 99%

“…4 Patients with rapid neurological deterioration because of impending herniation can benefit from decompression with craniectomy. 30,31 Following the immediate management of CVT, long-term vitamin K antagonists, such as warfarin, with a target international normalised ratio (INR) of 2-3 should be used. The duration of anticoagulation depends on aetiology.…”

Section: Management Of Cvtmentioning

confidence: 99%

See 1 more Smart Citation

Diagnosis and management of cerebral venous thrombosis

Behrouzi

Punter

2018

Clinical Medicine

View full text Add to dashboard Cite

Cerebral venous thrombosis (CVT) is rare and accounts for 0.5% of all strokes. Its clinical presentation is variable and diagnosis requires a high index of clinical suspicion in conjunction with neuroradiological diagnostic support. Treatment options are limited and are mostly based on consensus. Therefore, familiarity with international guidelines is important. Outcome is often good and most patients make a full recovery, although a small proportion suffers death or disability. Here, we describe the clinical features, risk factors, acute imaging features, management and complications of CVT.

show abstract

Section: Management Of Cvtmentioning

confidence: 99%

Section: Management Of Cvtmentioning

confidence: 99%

Diagnosis and management of cerebral venous thrombosis

Behrouzi

Punter

2018

Clinical Medicine

View full text Add to dashboard Cite

show abstract

“…The studies [123][124][125][126][127][128][129][130][131] included case reports (39 patients), case series (166 patients), two systematic reviews 125,131 and two non-randomised controlled studies. 123,124 The average death rate among patients treated with decompressive surgery (hemicraniectomy or haematoma evacuation) was 18.5%, the death or disability rate was 32.2%, the severe dependency rate only 3.4% and the complete recovery rate 30.7%.…”

Section: (Recommendations)mentioning

confidence: 99%

European Stroke Organization guideline for the diagnosis and treatment of cerebral venous thrombosis – Endorsed by the European Academy of Neurology

Ferro

Bousser

Canhão

et al. 2017

European Stroke Journal

154

103

View full text Add to dashboard Cite

The current proposal for cerebral venous thrombosis guideline followed the Grading of Recommendations, Assessment, Development, and Evaluation system, formulating relevant diagnostic and treatment questions, performing systematic reviews of all available evidence and writing recommendations and deciding on their strength on an explicit and transparent manner, based on the quality of available scientific evidence. The guideline addresses both diagnostic and therapeutic topics. We suggest using magnetic resonance or computed tomography angiography for confirming the diagnosis of cerebral venous thrombosis and not screening patients with cerebral venous thrombosis routinely for thrombophilia or cancer. We recommend parenteral anticoagulation in acute cerebral venous thrombosis and decompressive surgery to prevent death due to brain herniation. We suggest to use preferentially low-molecular weight heparin in the acute phase and not using direct oral anticoagulants. We suggest not using steroids and acetazolamide to reduce death or dependency. We suggest using antiepileptics in patients with an early seizure and supratentorial lesions to prevent further early seizures. We could not make recommendations due to very poor quality of evidence concerning duration of anticoagulation after the acute phase, thrombolysis and/or thrombectomy, therapeutic lumbar puncture, and prevention of remote seizures with antiepileptic drugs. We suggest that in women who suffered a previous cerebral venous thrombosis, contraceptives containing oestrogens should be avoided. We suggest that subsequent pregnancies are safe, but use of prophylactic low-molecular weight heparin should be considered throughout pregnancy and puerperium. Multicentre observational and experimental studies are needed to increase the level of evidence supporting recommendations on the diagnosis and management of cerebral venous thrombosis. KeywordsCerebral venous thrombosis, dural sinus thrombosis, Grading of Recommendations, Assessment, Development, and Evaluation, angiography, venography, D dimers, prothrombotic screening, cancer screening, anticoagulation, heparin, thrombolysis, thrombectomy, acetazolamide, steroids, decompressive surgery, hemicraniectomy, lumbar puncture, shunt, pregnancy, puerperium, contraception, antiepileptic drugs These guidelines followed the traditional methodology of combining review of scientific evidence with expert opinion and classifying evidence and recommendations in complex grading systems, using a matrix combining classes of recommendations with levels of evidence.Since 2010-2011 new information has accumulated on multiple aspects of the diagnosis and management of CVT. We aim to update previous EFNS guidelines using a clearer and evidence base methodology. To achieve that aim, the current proposal for CVT guidelines followed the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system, 3 formulating relevant diagnostic and treatment questions, performing systematic reviews of all available eviden...

show abstract

“…Surgical intervention can result in a good functional outcome even in the most severe cases of CVT 69 70. Early surgery (within 12 hours of admission), and younger patients are predictors of good outcome after decompressive craniectomy 68. There are no data to guide when to choose hemicraniectomy over endovascular management, or when and how to combine them in treating patients with severe thrombosis.…”

Section: Diagnosis and Managementmentioning

confidence: 99%

Current endovascular strategies for cerebral venous thrombosis: report of the SNIS Standards and Guidelines Committee

Lee

Mokin

Hetts

et al. 2018

J NeuroIntervent Surg

View full text Add to dashboard Cite

Decompressive craniectomy in cerebral venous thrombosis: a single centre experience

Abstract: 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.

Cited by 74 publications

References 27 publications

Diagnosis and management of cerebral venous thrombosis

Diagnosis and management of cerebral venous thrombosis

European Stroke Organization guideline for the diagnosis and treatment of cerebral venous thrombosis – Endorsed by the European Academy of Neurology

Current endovascular strategies for cerebral venous thrombosis: report of the SNIS Standards and Guidelines Committee

Contact Info

Product

Resources

About