Decompressive craniectomy in hemorrhagic cerebral venous thrombosis: clinicoradiological features and risk factors

Abstract

OBJECTIVE Decompressive craniectomy (DC) is a life-saving treatment for severe hemorrhagic cerebral venous thrombosis (CVT). However, the correlations between the clinicoradiological features and surgical outcomes of this disease are not well established. Therefore, the authors endeavored to analyze the potential risk factors for this more severe subtype of CVT and to provide more evidence regarding the benefits of DC in patients with hemorrhagic CVT. METHODS The clinical features, radiological findings, and surgical outcomes of patients with severe hemorrhagic CVT who had undergone DC treatment in the period from January 2005 to March 2015 were retrospectively analyzed, and the risk factors for this disease were evaluated. RESULTS Fifty-eight patients, 39 females (67.2%) and 19 males (32.8%), with a mean age of 39.7 ± 12.5 years, were included in this study. The mean duration from symptom onset to surgery was 3.3 ± 1.9 days, and 21 patients experienced acute courses. On neuroimaging, the mean mass lesion volume was 114.7 ± 17.7 ml. Nine patients had bilateral lesions, and 7 patients had deep CVT. According to their hemorrhagic proportion, cases were divided into hemorrhage-dominated (27 [46.6%]) and edema-dominated (31 [53.4%]) groups. After 6 months of follow-up, 56.9% of patients had achieved a favorable outcome, and 8 patients had died. The hemorrhage-dominated lesions (p = 0.026) and deep cerebral venous involvement (p = 0.026) were significantly associated with a poor outcome. CONCLUSIONS In patients suffering from severe hemorrhagic CVT, DC is an effective life-saving treatment that is associated with favorable outcomes. Hemorrhage-dominated lesions and deep cerebral venous involvement have a significant impact on the outcome of this disease.

The Conundrum of Ventricular Dilatations Following Decompressive Craniectomy: Is Ventriculoperitoneal Shunt, The Only Panacea?

“…Mostly reserved for trauma-related causes, the indications for DC have been broadened to include a variety of etiologies such as spontaneous intracerebral hematoma, cerebral venous sinus thrombosis, malignant middle cerebral artery infarct, and subarachnoid hemorrhage. [ 2 6 7 8 9 ] The growing acceptance of this technique for various etiologies began to expose the different complications associated with it. PDCH is one peculiar complication associated with this technique.…”

Surgical Superior Sagittal Sinus Thrombectomy in Refractory Thrombosis: A Technical Note

“…Although some authors have described restarting anticoagulation within 24 h, others advocate waiting up to 8 days [3, 16, 17]. Surgical clot removal during decompression may aid in preventing clot progression during the “unprotected” postoperative window, between decompression and when anticoagulation is resumed, although, in the present case, systemic anticoagulation was not held postoperatively.…”

“…Traditionally, surgical management of CVT has been limited to decompressive craniectomy or cerebrospinal fluid diversion for the treatment of intracranial hemorrhage with mass effect and for the rapid control of ICP [15, 16]. However, outcome in this subset of patients requiring aggressive surgical management is unfavorable in up to 44% of patients [15].…”

Assessment of Skin Flaps Above Cranial Defects Following Craniectomy: A Proposed Classification System

“…Decompressive craniectomy is a common neurosurgical procedure used to manage refractory intracranial hypertension. [1][2][3][4][5][6] Frequent indications for decompressive craniectomy are traumatic brain injury (TBI) and ischemic stroke. [7][8][9] Importantly, changes of the skin flap above the craniectomy defect (SCD) acutely or subacutely after surgery may signal postoperative complications such as hemorrhage, infection or inflammation, cerebrospinal fluid (CSF) flow disturbance, or paradoxical brain herniation.…”