Skip to main content

Advertisement

Log in

Decompressive surgery in malignant cerebral venous sinus thrombosis: what predicts its outcome?

  • Published:
Journal of Thrombosis and Thrombolysis Aims and scope Submit manuscript

Abstract

Cerebral venous sinus thrombosis (CVST) is common in Asians, accounting for 15% of all strokes in the young. CVST causing malignant cerebral oedema with brain herniation and death are referred as malignant CVST. This study was aimed at evaluating the outcome of patients and factors predicting the outcome with malignant CVST after decompressive surgery. It was a retrospective, observational, single centre, hospital-based and cross-sectional study. Records of patients with malignant CVST who had decompressive surgery were analysed. Over 5 years (2010–2015), 30 patients (15 men and 15 women) underwent decompressive surgery. In univariate analysis, age more than 50 years (p = 0.05); presence of midline shift of more than 10 mm (p = 0.03) and total effacement of basal cisterns (p = 0.01) had significant correlation with poor outcome. On multivariate analysis, presence of midline shift of more than 10 mm (p = 0.01) was a significant predictor of poor outcome. Decompressive surgery is a life saving therapeutic intervention in patients with malignant CVST and more than two-thirds of patient shows favourable outcome. Age more than 50 years, midline shift >10 mm and total effacement of basal cisterns determine poor outcome following decompressive surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Wasay M, Kamal AK (2006) Cerebral venous thrombosis: recent advances and need for an Asian registry. J Pak Med Assoc 56:483–484

    PubMed  Google Scholar 

  2. Stam J (2005) Thrombosis of the cerebral veins and sinuses. N Engl J Med 352:1791–1798

    Article  CAS  PubMed  Google Scholar 

  3. Nagaraja D, Taly AB, Das S (1989) Puerperal cerebral venous thrombosis in India. In: Sinha KK, Chandra P (eds) Progress in clinical neurosciences, NSI Publication, Ranchi, 165–177

    Google Scholar 

  4. Bentley JN, Figueroa RE, Vender JR (2009) From presentation to follow-up: diagnosis and treatment of cerebral venous thrombosis. Neurosurg Focus 27:E4

    Article  PubMed  Google Scholar 

  5. Dentali F, Gianni M, Crowther MA, Ageno W (2006) Natural history of cerebral vein thrombosis: a systematic review. Blood 108:1129–1134

    Article  CAS  PubMed  Google Scholar 

  6. Canha˜o P, Ferro JM, Lindgren AG, Bousser MG, Stam J, Barinagarrementeria F, ISCVT Investigators (2005) Causes and predictors of death in cerebral venous thrombosis. Stroke 36:1720–1725

    Article  Google Scholar 

  7. Théaudin M, Crassard I, Bresson D, Saliou G, Favrole P, Vahedi K et al (2010) Should decompressive surgery be performed in malignant cerebral venous thrombosis?: a series of 12 patients. Stroke 41:727–731

    Article  PubMed  Google Scholar 

  8. Bousser MG, Ferro JM (2007) Cerebral venous thrombosis: an update. Lancet Neurol 6:162–170

    Article  CAS  PubMed  Google Scholar 

  9. van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van Gijn J (1988) Interobserver agreement for the assessment of handicap in stroke patients. Stroke 19:604–607

    Article  PubMed  Google Scholar 

  10. Keller E, Pangalu A, Fandino J, Könü D, Yonekawa Y (2005) Decompressive craniectomy in severe cerebral venous and dural sinus thrombosis. Acta Neurochir Suppl 94:177–183

    Article  CAS  PubMed  Google Scholar 

  11. Coutinho JM, Majoie CB, Coert BA, Stam J (2009) Decompressive hemicraniectomy in cerebral sinus thrombosis: consecutive case series and review of the literature. Stroke 40:2233–2235

    Article  PubMed  Google Scholar 

  12. Caso V, Billeci AM, Leys D (2008) Interventional neuroradiology in the treatment of cerebral venous thrombosis. Front Neurol Neurosci 23:144–160

    PubMed  Google Scholar 

  13. Einhäupl K, Bousser MG, de Bruijn SF, Ferro JM, Martinelli I, Masuhr F et al (2006) EFNS guideline on the treatment of cerebral venous and sinus thrombosis. Eur J Neurol 13:553–559

    Article  PubMed  Google Scholar 

  14. Vahedi K, Hofmeijer J, Juettler E, Vicaut E, George B, Algra A et al (2007) DECIMAL, DESTINY, and HAMLET investigators. Early decompressive surgery in malignant infarction of the middle cerebral artery: a pooled analysis of three randomised controlled trials. Lancet Neurol 6:215–222

    Article  PubMed  Google Scholar 

  15. Ferro JM, Canha˜o P, Stam J, Bousser MG, Barinagarrementeria F, ISCVT Investigators (2004) Prognosis of cerebral vein and dural sinus thrombosis: results of the international study on cerebral vein and dural sinus thrombosis (ISCVT). Stroke 35:664–670

    Article  PubMed  Google Scholar 

  16. Masdeu JC, Irimia P, Asenbaum S, Bogousslavsky J, Brainin M, Chabriat H et al (2006) EFNS guideline on neuroimaging in acute stroke. Report of an EFNS task force. Eur J Neurol 13:1271–1283

    Article  CAS  PubMed  Google Scholar 

  17. Ferro JM, Crassard I, Coutinho JM, Canha˜o P, Barinagarrementeria F, Cucchiara B et al (2011) Decompressive surgery in cerebrovenous thrombosis: a multicenter registry and a systematic review of individual patient data. Stroke 42:2825–2831

    Article  PubMed  Google Scholar 

  18. Aaron S, Alexander M, Moorthy RK, Mani S, Mathew V, Patil AK et al (2013) Decompressive craniectomy in cerebral venous thrombosis: a single centre experience. J Neurol Neurosurg Psychiatry 84:995–1000

    Article  PubMed  Google Scholar 

  19. Vivakaran TTR, Srinivas D, Kulkarni GB, Somanna S (2012) The role of decompressive craniectomy in cerebral venous sinus thrombosis. J Neurosurg 117:738–744

    Article  Google Scholar 

  20. Mohindra S, Umredkar A, Singla N, Bal A, Gupta SK (2011) Decompressive craniectomy for malignant cerebral oedema of cortical venous thrombosis: an analysis of 13 patients. Br J Neurosurg 25:422–429

    Article  PubMed  Google Scholar 

  21. Zuurbier SM, Coutinho JM, Majoie CB, Coert BA, Munckhof P, Stam J (2012) Decompressive hemicraniectomy in severe cerebral venous thrombosis: a prospective case series. J Neurol 259:1099–1105

    Article  PubMed  Google Scholar 

  22. Lath R, Kumar S, Reddy R, Boola GR, Ray A, Prabhakar S et al (2010) Decompressive surgery for severe cerebral venous sinus thrombosis. Neurol India 58:392–397

    Article  PubMed  Google Scholar 

  23. Saposnik G, Barinagarrementeria F, Brown RD Jr, Bushnell CD, Cucchiara B, Cushman M, on behalf of the American Heart Association Stroke Council and the Council on Epidemiology and Prevention et al (2011) Diagnosis and management of cerebral venous thrombosis: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 42:1158–1192

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

Authors thank their colleagues in the department of Neurology and Neurosurgery for aiding in patient management.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Rohan Mahale.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mahale, R., Mehta, A., Varma, R.G. et al. Decompressive surgery in malignant cerebral venous sinus thrombosis: what predicts its outcome?. J Thromb Thrombolysis 43, 530–539 (2017). https://doi.org/10.1007/s11239-017-1489-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11239-017-1489-x

Keywords

Navigation