Decompressive hemicraniectomy in cerebral sinus thrombosis: consecutive case series and review of the literature.
OBJECTIVE
Thirteen percent of patients with cerebral venous and sinus thrombosis (CVST) has a poor clinical outcome. In patients with a poor prognosis, endovascular thrombolysis can be considered, but this procedure does not appear to be beneficial in patients with impending transtentorial herniation because of large hemorrhagic venous infarcts. Therefore, halfway through 2006, we changed our policy to decompressive hemicraniectomy in these patients.


METHODS
Patients with CVST and impending herniation attributable to venous infarcts were eligible for surgical intervention. Since 2006 we consecutively treated 3 patients with decompressive hemicraniectomy. Two patients had an excellent outcome. The third patient, who had been comatose for at least 12 hours before surgery, died despite intervention.


CONCLUSIONS
Our data suggest that decompressive hemicraniectomy can be life-saving and can result in an excellent outcome in patients with severe CVST.
Jonathan M
JM
Coutinho
Charles B L M
CB
Majoie
Bert A
BA
Coert
Jan
J
Stam
D000328:Adult; D002543:Cerebral Hemorrhage / Q000150:complications / Q000473:pathology / Q000601:surgery; D002544:Cerebral Infarction / Q000150:complications / Q000473:pathology / Q000601:surgery; D003399:Craniotomy; D019299:Decompression, Surgical; D017809:Fatal Outcome; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012640:Seizures / Q000209:etiology; D012851:Sinus Thrombosis, Intracranial / Q000601:surgery*; D019291:Skull Base / Q000473:pathology / Q000601:surgery; D014057:Tomography, X-Ray Computed