Decompressive Surgery for Malignant Cerebral Venous Sinus Thrombosis: A Retrospective Case Series from Pakistan and Comparative Literature Review

Raza, Emmon; Shamim, Muhammad Shahzad; Wadiwala, Muhammad Faisal; Ahmed, Bilal; Kamal, Ayeesha Kamran

doi:10.1016/j.jstrokecerebrovasdis.2013.07.045

Cited by 27 publications

(20 citation statements)

References 31 publications

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“…Several studies reported infectious, inflammatory, and/or wound healing complications following DC without specifying the location [13, 15, 19, 21, 27, 30, 37, 61, 62, 86, 90–93]. In these cases, the rate reported in stroke patients was highest at 13.7 % (29/212), compared to TBI at 6.4 % (32/500).…”

Section: Resultsmentioning

confidence: 99%

Complications Associated with Decompressive Craniectomy: A Systematic Review

et al. 2015

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Decompressive craniectomy (DC) has been used for many years in the management of patients with elevated intracranial pressure and cerebral edema. Ongoing clinical trials are investigating the clinical and cost effectiveness of DC in trauma and stroke. While DC has demonstrable efficacy in saving life, it is accompanied by a myriad of non-trivial complications that have been inadequately highlighted in prospective clinical trials. Missing from our current understanding is a comprehensive analysis of all potential complications associated with DC. Here, we review the available literature, we tabulate all reported complications, and we calculate their frequency for specific indications. Of over 1500 records initially identified, a final total of 142 eligible records were included in our comprehensive analysis. We identified numerous complications related to DC that have not been systematically reviewed. Complications were of three major types: (1) Hemorrhagic (2) Infectious/Inflammatory, and (3) Disturbances of the CSF compartment. Complications associated with cranioplasty fell under similar major types, with additional complications relating to the boneflap. Overall, one of every ten patients undergoing DC may suffer a complication necessitating additional medical and/or neurosurgical intervention. While DC has received increased attention as a potential therapeutic option in a variety of situations, like any surgical procedure, DC is not without risk. Neurologists and neurosurgeons must be aware of all the potential complications of DC in order to properly advise their patients.

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Section: Resultsmentioning

confidence: 99%

Complications Associated with Decompressive Craniectomy: A Systematic Review

et al. 2015

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“…The available evidence led to a recommendation for surgical decompression in patients with severe CVT early in the time course of the disease. 14,26,31,34 Endovascular treatment options are increasingly advocated, particularly mechanical thrombectomy, with good recanalization rates. While partial or complete restoration of flow was reached in many cases with multimodal treatment, the mortality rate remained high.…”

Section: Discussionmentioning

confidence: 99%

Cerebral venous thrombosis requiring invasive treatment for elevated intracranial pressure in women with combined hormonal contraceptive intake: risk factors, anatomical distribution, and clinical presentation

Roethlisberger¹,

Gut²,

Zumofen

et al. 2018

Neurosurgical Focus

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OBJECTIVEWomen taking combined hormonal contraceptives (CHCs) are generally considered to be at low risk for cerebral venous thrombosis (CVT). When it does occur, however, intensive care and neurosurgical management may, in rare cases, be needed for the control of elevated intracranial pressure (ICP). The use of nonsurgical strategies such as barbiturate coma and induced hypothermia has never been reported in this context. The objective of this study is to determine predictive factors for invasive or surgical ICP treatment and the potential complications of nonsurgical strategies in this population.METHODSThe authors conducted a 2-center, retrospective chart review of 168 cases of CVT in women between 2000 and 2012. Eligible patients were classified as having had a mild or a severe clinical course, the latter category including all patients who underwent invasive or surgical ICP treatment and all who had an unfavorable outcome (modified Rankin Scale score ≥ 3 or Glasgow Outcome Scale score ≤ 3). The Mann-Whitney U-test was used for continuous parameters and Fisher’s exact test for categorical parameters, and odds ratios were calculated with statistical significance set at p ≤ 0.05.RESULTSOf the 168 patients, 57 (age range 16–49 years) were determined to be eligible for the study. Six patients (10.5%) required invasive or surgical ICP treatment. Three patients (5.3%) developed refractory ICP > 30 mm Hg despite early surgical decompression; 2 of them (3.5%) were treated with barbiturate coma and induced hypothermia, with documented infectious, thromboembolic, and hemorrhagic complications. Coma on admission, thrombosis of the deep venous system with consecutive hydrocephalus, intraventricular hemorrhage, and hemorrhagic venous infarction were associated with a higher frequency of surgical intervention. Coma, quadriparesis on admission, and hydrocephalus were more commonly seen among women with unfavorable outcomes. Thrombosis of the transverse sinus was less common in patients with an unfavorable outcome, with similar distribution in patients needing invasive or surgical ICP treatment.CONCLUSIONSThe need for invasive or surgical ICP treatment in women taking CHCs who have CVT is partly predictable on the basis of the clinical and radiological findings on admission. The use of nonsurgical treatments for refractory ICP, such as barbiturate coma and induced hypothermia, is associated with systemic infectious and hematological complications and may worsen morbidity in this patient population. The significance of these factors should be studied in larger multicenter cohorts.

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“…19,20 Thus far, however, only a limited number of studies with small samples have retrospectively analyzed the outcomes of patients with severe CVT who underwent DC (Table 4). 1,9,[12][13][14][15][16][17]22,25 Given the lack of universal surgical indications, the results of these studies vary with mortality rates ranging from 0% to 28.6% and good functional outcome rates ranging from 56.5% to 100%. In the present study, the overall mortality rate was 13.8%, and 33 patients (56.9%) achieved good functional outcomes.…”

Section: Discussionmentioning

confidence: 99%

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

Zhao

et al. 2017

Journal of Neurosurgery

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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.

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Decompressive Surgery for Malignant Cerebral Venous Sinus Thrombosis: A Retrospective Case Series from Pakistan and Comparative Literature Review

Cited by 27 publications

References 31 publications

Complications Associated with Decompressive Craniectomy: A Systematic Review

Complications Associated with Decompressive Craniectomy: A Systematic Review

Cerebral venous thrombosis requiring invasive treatment for elevated intracranial pressure in women with combined hormonal contraceptive intake: risk factors, anatomical distribution, and clinical presentation

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

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