title: Decompressive hemicraniectomy in severe cerebral venous thrombosis: a prospective case series.
abstract: Small retrospective case series suggest that decompressive hemicraniectomy can be life saving in patients with cerebral venous thrombosis (CVT) and impending brain herniation. Prospective studies of consecutive cases are lacking. Thus, a single centre, prospective study was performed. In 2006 we adapted our protocol for CVT treatment to perform acute decompressive hemicraniectomy in patients with impending herniation, in whom the prognosis with conservative treatment was considered infaust. We included all consecutive patients with CVT between 2006 and 2010 who underwent hemicraniectomy. Outcome was assessed at 12 months with the modified Rankin Scale (mRS). Ten patients (8 women) with a median age of 41 years (range 26-52 years) were included. Before surgery 5 patients had GCS < 9, 9 patients had normal pupils, 1 patient had a unilaterally fixed and dilated pupil. All patients except one had space-occupying intracranial hemorrhagic infarcts. The median preoperative midline shift was 9 mm (range 3-14 mm). Unilateral hemicraniectomy was performed in 9 patients and bilateral hemicraniectomy in one. Two patients died from progressive cerebral edema and expansion of the hemorrhagic infarcts. Five patients recovered without disability at 12 months (mRS 0-1). Two patients had some residual handicap (one minor, mRS 2; one moderate, mRS 3). One patient was severely handicapped (mRS 5). Our prospective data show that decompressive hemicraniectomy in the most severe cases of cerebral venous thrombosis was probably life saving in 8/10 patients, with a good clinical outcome in six. In 2 patients death was caused by enlarging hemorrhagic infarcts.
authors: Department of Neurology, Academic Medical Centre, University of Amsterdam, Room H2-226, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
authors: Susanna M
authors: SM
authors: Zuurbier
authors: Jonathan M
authors: JM
authors: Coutinho
authors: Charles B L M
authors: CB
authors: Majoie
authors: Bert A
authors: BA
authors: Coert
authors: Pepijn
authors: P
authors: van den Munckhof
authors: Jan
authors: J
authors: Stam
mesh_terms: D000328:Adult; D003399:Craniotomy / Q000379:methods; D019299:Decompression, Surgical / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020767:Intracranial Thrombosis / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000473:pathology / Q000601:surgery