Prognosis of patients with severe cerebral venous thrombosis treated with decompressive craniectomy

OBJECTIVEDecompressive craniectomy (DC) is a life-saving treatment for severe hemorrhagic cerebral venous thrombosis (CVT). However, the correlations between the clinicoradiological features and surgical outcomes of this disease are not well established. Therefore, the authors endeavored to analyze the potential risk factors for this more severe subtype of CVT and to provide more evidence regarding the benefits of DC in patients with hemorrhagic CVT.METHODSThe clinical features, radiological findings, and surgical outcomes of patients with severe hemorrhagic CVT who had undergone DC treatment in the period from January 2005 to March 2015 were retrospectively analyzed, and the risk factors for this disease were evaluated.RESULTSFifty-eight patients, 39 females (67.2%) and 19 males (32.8%), with a mean age of 39.7 ± 12.5 years, were included in this study. The mean duration from symptom onset to surgery was 3.3 ± 1.9 days, and 21 patients experienced acute courses. On neuroimaging, the mean mass lesion volume was 114.7 ± 17.7 ml. Nine patients had bilateral lesions, and 7 patients had deep CVT. According to their hemorrhagic proportion, cases were divided into hemorrhage-dominated (27 [46.6%]) and edema-dominated (31 [53.4%]) groups. After 6 months of follow-up, 56.9% of patients had achieved a favorable outcome, and 8 patients had died. The hemorrhage-dominated lesions (p = 0.026) and deep cerebral venous involvement (p = 0.026) were significantly associated with a poor outcome.CONCLUSIONSIn patients suffering from severe hemorrhagic CVT, DC is an effective life-saving treatment that is associated with favorable outcomes. Hemorrhage-dominated lesions and deep cerebral venous involvement have a significant impact on the outcome of this disease.

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Malignant cerebral infarction, systemic venous thrombosis and thrombocytopenia after ChAdOx1 nCov vaccination: a possible catastrophic variant of vaccine induced thrombotic thrombocytopenia

10.21203/rs.3.rs-448338/v1 ◽

2021 ◽

Author(s):

Manuela De Michele ◽

Marta Iacobucci ◽

Ettore Nicolini ◽

Antonio Chistolini ◽

Fabio Pulcinelli ◽

...

Keyword(s):

Young Adults ◽

Portal Vein ◽

Cerebral Infarction ◽

Venous Thrombosis ◽

Middle Cerebral Artery ◽

Decompressive Craniectomy ◽

Cerebral Venous Thrombosis ◽

Platelet Factor ◽

Vein Thrombosis ◽

High Level

Abstract Vaccine induced thrombotic thrombocytopenia is a new syndrome recently described in young adults within two weeks from the first dose of the ChAdOx1 nCoV-19 vaccine and characterized by cerebral venous thrombosis. We report two cases of malignant middle cerebral artery (MCA) infarct and thrombocytopenia within 10 days after vaccination with ChAdOx1 nCoV-19. Patient 1 was a 57-year-old woman who underwent decompressive craniectomy despite two successful mechanical thrombectomies. Patient 2 was a 55-year-old woman who developed a fatal bilateral malignant MCA infarct. Both the patients had pulmonary and portal vein thrombosis and high level of antibodies to platelet factor 4-polyanion complexes.

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Decompressive craniectomy for cerebral venous thrombosis

Platelets ◽

10.3109/09537104.2011.557452 ◽

2011 ◽

Vol 22 (6) ◽

pp. 478-478 ◽

Cited By ~ 1

Author(s):

Satoru Takeuchi ◽

Hiroshi Nawashiro

Keyword(s):

Venous Thrombosis ◽

Decompressive Craniectomy ◽

Cerebral Venous Thrombosis

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Bilateral Decompressive Craniectomy in Malignant Cerebral Venous Thrombosis

European Journal of Case Reports in Internal Medicine ◽

10.12890/2020_001560 ◽

2020 ◽

Author(s):

Eduardo Soriano-Navarro ◽

Vanessa Cano-Nigenda ◽

Fernanda Menéndez-Manjarrez ◽

Esmirna Farington-Terrero ◽

Juan José Méndez-Gallardo ◽

...

Keyword(s):

Venous Thrombosis ◽

Decompressive Craniectomy ◽

Cerebral Venous Thrombosis ◽

Cerebral Oedema ◽

Therapeutic Option ◽

Midline Shift ◽

Sagittal Sinus ◽

Life Saving ◽

Venous Infarcts

Introduction: Despite the extremely favourable prognosis of patients with cerebral venous thrombosis (CVT), death occurs in 10–15% of patients. In severe cases of malignant CVT with supratentorial haemorrhagic lesions, cerebral oedema and brain herniation, decompressive surgery may be the only life-saving treatment. Patient and methods: We present the case of a puerperal young woman with progressive headache, seizures and decreased alertness. Thrombosis of the entire superior sagittal sinus with bifrontal venous infarcts and midline shift was confirmed by magnetic resonance imaging with venography sequencing. Despite medical treatment with anticoagulation, progressive neurological deterioration was observed, so bilateral, frontal decompressive craniectomy was performed. Results: At the 6-month follow-up, we observed partial functional recovery with a modified Rankin score of 3. Discussion: Bilateral decompressive craniectomy may be a life-saving therapeutic option when medical therapy fails and there are clinical and radiological features of progression in both cerebral hemispheres.

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