title: Decompressive surgery in cerebrovenous thrombosis: a multicenter registry and a systematic review of individual patient data.
abstract: OBJECTIVE
  Herniation attributable to unilateral mass effect is the major cause of death in cerebral venous thrombosis (CVT). Decompressive surgery may be lifesaving in these patients.
  
  
  METHODS
  Retrospective registry of cases of acute CVT treated with decompressive surgery (craniectomy or hematoma evacuation) in 22 centers and systematic review of all published cases of CVT treated with decompressive surgery. The primary outcome was the score on the modified Rankin Scale (mRS) score at last follow-up, dichotomized between favorable (mRS score, 0-4) and unfavorable outcome (mRS score, 5 or death). Secondary outcomes were complete recovery (mRS score 0-1), independence (mRS score, 0-2), severe dependence (mRS score, 4-5), and death at last available follow-up.
  
  
  RESULTS
  Sixty-nine patients were included and 38 were from the registry. Decompressive craniectomy was performed in 45 patients, hematoma evacuation was performed in 7, and both interventions were performed in 17 patients. At last follow-up (median, 12 months) only 12 (17.4%) had un unfavorable outcome. Twenty-six (37.7%) had mRS score 0 to 1, 39 (56.5%) had mRS score 0 to 2, 4 (5.8%) were alive with mRS score 4 to 5, and 11 (15.9%) patients died. Three of the 9 patients with bilateral fixed pupils recovered completely. Comatose patients were less likely to be independent (mRS score 0-2) than noncomatose patients (45% versus 84%; P=0.003). Patients with bilateral lesions were more likely to have unfavorable outcomes (50% versus 11%; P=0.004) and to die (42% versus 11%; P=0.025).
  
  
  CONCLUSIONS
  In CVT patients with large parenchymal lesions causing herniation, decompressive surgery was lifesaving and often resulted in good functional outcome, even in patients with severe clinical conditions.
authors.affiliation: Department of Neurosciences, Hospital Santa Maria, University of Lisbon, 1649-035 Lisbon, Portugal. jmferro@fm.ul.pt
authors.forename: José M
authors.initials: JM
authors.lastname: Ferro
authors.forename: Isabelle
authors.initials: I
authors.lastname: Crassard
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Coutinho
authors.forename: Patrícia
authors.initials: P
authors.lastname: Canhão
authors.forename: Fernando
authors.initials: F
authors.lastname: Barinagarrementeria
authors.forename: Brett
authors.initials: B
authors.lastname: Cucchiara
authors.forename: Laurent
authors.initials: L
authors.lastname: Derex
authors.forename: Christoph
authors.initials: C
authors.lastname: Lichy
authors.forename: Jaime
authors.initials: J
authors.lastname: Masjuan
authors.forename: Ayrton
authors.initials: A
authors.lastname: Massaro
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Matamala
authors.forename: Sven
authors.initials: S
authors.lastname: Poli
authors.forename: Mohammad
authors.initials: M
authors.lastname: Saadatnia
authors.forename: Erwin
authors.initials: E
authors.lastname: Stolz
authors.forename: Miguel
authors.initials: M
authors.lastname: Viana-Baptista
authors.forename: Jan
authors.initials: J
authors.lastname: Stam
authors.forename: Marie-Germaine
authors.initials: MG
authors.lastname: Bousser
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003399:Craniotomy / Q000379:methods*; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D015600:Glasgow Coma Scale; D006801:Humans; D020767:Intracranial Thrombosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012042:Registries; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000601:surgery*