title: Shunting in acute cerebral venous thrombosis: a systematic review.
abstract: OBJECTIVE
  The efficacy of cerebrospinal fluid shunting to reduce intracranial hypertension and prevent fatal brain herniation in acute cerebral venous thrombosis (CVT) is unknown.
  
  
  METHODS
  From the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT) and a systematic literature review, we retrieved acute CVT patients treated only with shunting (external ventricular drain, ventriculoperitoneal or ventriculojugular shunt). Outcome was classified at 6 months and final follow-up by the modified Rankin Scale (mRS).
  
  
  RESULTS
  15 patients were collected (9 from the ISCVT and 6 from the review) who were treated with a shunt (external ventricular drain in 6 patients, a ventriculoperitoneal shunt in 8 patients or an unspecified type of shunt in another one). Eight patients (53.3%) regained independence (mRS 0-2), while 2 patients (13.3%) were left with a severe handicap (mRS 4-6) and 4 (26.7%) died despite treatment. Five patients with parenchymal lesions were shunted within 48 h from admission deterioration, 4 with an external ventricular drain: 2 (40%) recovered to independence, 2 (40%) had a severe handicap and 1 (20%) died. In contrast, all 3 patients with intracranial hypertension and no parenchymal lesions receiving a ventriculoperitoneal shunt later than 48 h regained independence.
  
  
  CONCLUSIONS
  A quarter of acute CVT patients treated with a shunt died, and only half regained independence. With the limitation of the small number of subjects, this review suggests that shunting does not appear to be effective in preventing death from brain herniation in acute CVT. We cannot exclude that shunting may benefit patients with sustained intracranial hypertension and no parenchymal lesions.
authors.affiliation: Department of Neurosciences (Neurology), Hospital de Santa Maria, University of Lisbon, Lisbon, Portugal.
authors.forename: S
authors.initials: S
authors.lastname: Lobo
authors.forename: J M
authors.initials: JM
authors.lastname: Ferro
authors.forename: F
authors.initials: F
authors.lastname: Barinagarrementeria
authors.forename: M G
authors.initials: MG
authors.lastname: Bousser
authors.forename: P
authors.initials: P
authors.lastname: Canhão
authors.forename: J
authors.initials: J
authors.lastname: Stam
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001925:Brain Damage, Chronic / Q000453:epidemiology / Q000209:etiology; D001929:Brain Edema / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control / Q000601:surgery; D002550:Cerebral Veins; D002557:Cerebrospinal Fluid Shunts; D002648:Child; D002675:Child, Preschool; D004677:Encephalocele / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D005260:Female; D006801:Humans; D007223:Infant; D019586:Intracranial Hypertension / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control / Q000601:surgery*; D020767:Intracranial Thrombosis / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D012851:Sinus Thrombosis, Intracranial / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D055815:Young Adult