Should decompressive surgery be performed in malignant cerebral venous thrombosis?: a series of 12 patients.
OBJECTIVE
In malignant cerebral venous thrombosis (CVT) patients, emergency decompressive surgery has been suggested as a life-saving procedure. We report 12 patients with malignant CVT, among whom 8 underwent operation.


METHODS
Retrospective study of 12 patients from 3 stroke units who had a malignant CVT as defined: (1) supratentorial cortical lesions attributable to superficial venous system thrombosis with or without sinus involvement; (2) with clinical (decreased consciousness and dilated pupils) or radiological signs of transtentorial herniation; (3) either at onset or after worsening despite heparin therapy. Surgery or abstention was decided individually by neurosurgeons on call.


RESULTS
There were 9 women and 3 men with a mean age of 45+/-15 years. The delay between heparin therapy and signs of malignancy ranged from 2 to 30 hours. At malignant worsening all but 1 patient had hemorrhagic lesions; the median deviation of septum pellucidum was 12 mm (interquartile range, 6.7-13); 5 patients (including 3 who underwent operation) had a unilateral dilated pupil; and 4 (2 who underwent operation) had bilateral dilated pupils. Eight patients underwent surgical decompression, external decompression in 4, both external and internal decompression in 3, and internal decompression in 1. The 4 patients who did not undergo operation died within 1 to 5 days after diagnosis. One patient who underwent operation died of a pulmonary embolism. The 7 others survived, with, at last follow-up (median, 23.1 months; interquartile range, 19.7-45.6), an excellent recovery of mRS 0 or 1 in 6 and mRS 3 in 1.


CONCLUSIONS
Decompressive surgery may save lives and may even allow a good functional outcome in malignant CVT, even in patients with bilateral dilated pupils.
Théaudin
Marie
M
AP-HP, Hôpital Bicêtre, Service de Neurologie, Le Kremlin-Bicêtre, France. marie.theaudin@bct.aphp.fr
Crassard
Isabelle
I
Bresson
Damien
D
Saliou
Guillaume
G
Favrole
Pascal
P
Vahedi
Katayoun
K
Denier
Christian
C
Bousser
Marie-Germaine
MG
D000293:Adolescent; D000328:Adult; D000368:Aged; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D006801:Humans; D020767:Intracranial Thrombosis / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D055815:Young Adult