title: Decompressive craniectomy in cerebral venous thrombosis: a single centre experience.
abstract: BACKGROUND
  Cerebral venous thrombosis (CVT) is an important cause for stroke in the young where the role for decompressive craniectomy is not well established.
  
  
  OBJECTIVE
  To analyse the outcome of CVT patients treated with decompressive craniectomy.
  
  
  METHODS
  Clinical and imaging features, preoperative findings and long-term outcome of patients with CVT who underwent decompressive craniectomy were analysed.
  
  
  RESULTS
  Over 10 years (2002-2011), 44/587 (7.4%) patients with CVT underwent decompressive craniectomy. Diagnosis of CVT was based on magnetic resonance venography (MRV)/inferior vena cava (IVC). Decision for surgery was taken at admission in 19/44 (43%), within 12 h in 5/44 (11%), within first 48 h in 15/44 (34%) and beyond 48 h in 10/44 (22%). Presence of midline shift of ≥ 10 mm (p<0.0009) and large infarct volume (mean 146.63 ml; SD 52.459, p<0.001) on the baseline scan influenced the decision for immediate surgery. Hemicraniectomy was done in 38/44 (86%) and bifrontal craniectomy in 6/44 (13.6%). Mortality was 9/44 (20%). On multivariate analysis (5% level of significance) age <40 years and surgery within 12 h significantly increased survival. Mean follow-up was 25.5 months (range 3-66 months), 26/35 (74%) had 1 year follow-up. Modified Rankin Scale (mRs) continued to improve even after 6 months with 27/35 (77%) of survivors achieving mRs of ≤ 2.
  
  
  CONCLUSIONS
  This is the largest series on decompressive craniectomy for CVT in literature to date. Decompressive craniotomy should be considered as a treatment option in large venous infarcts. Very good outcomes can be expected especially if done early and in those below 40 years.
authors.affiliation: Neurology Unit, Department of Neurological Sciences, Christian Medical College & Hospital, Vellore, Tamil Nadu, India.
authors.forename: Sanjith
authors.initials: S
authors.lastname: Aaron
authors.forename: Mathew
authors.initials: M
authors.lastname: Alexander
authors.forename: Ranjith K
authors.initials: RK
authors.lastname: Moorthy
authors.forename: Sunithi
authors.initials: S
authors.lastname: Mani
authors.forename: Vivek
authors.initials: V
authors.lastname: Mathew
authors.forename: Anil Kumar B
authors.initials: AK
authors.lastname: Patil
authors.forename: Ajith
authors.initials: A
authors.lastname: Sivadasan
authors.forename: Shalini
authors.initials: S
authors.lastname: Nair
authors.forename: Mathew
authors.initials: M
authors.lastname: Joseph
authors.forename: Maya
authors.initials: M
authors.lastname: Thomas
authors.forename: Krishna
authors.initials: K
authors.lastname: Prabhu
authors.forename: Baylis Vivek
authors.initials: BV
authors.lastname: Joseph
authors.forename: Vedantam
authors.initials: V
authors.lastname: Rajshekhar
authors.forename: Ari George
authors.initials: AG
authors.lastname: Chacko
mesh_terms: D000328:Adult; D002544:Cerebral Infarction / Q000473:pathology; D056424:Decompressive Craniectomy / Q000379:methods* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D007839:Functional Laterality / Q000502:physiology; D015600:Glasgow Coma Scale; D006801:Humans; D007091:Image Processing, Computer-Assisted; D020767:Intracranial Thrombosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011183:Postoperative Complications / Q000453:epidemiology / Q000628:therapy; D011859:Radiography; D012189:Retrospective Studies; D020521:Stroke / Q000601:surgery; D013524:Surgical Flaps; D016019:Survival Analysis; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D055815:Young Adult
keywords: SINUS THROMBOSIS; SURGERY