J Cerebrovasc Endovasc Neurosurg.  2022 Jun;24(2):129-136. 10.7461/jcen.2022.E2021.07.012.

Efficiency of decompressive craniectomy as a line of management of severe cerebral venous thrombosis

• Elsherbini MM
• Badr H
• Khalil AF

• KMID: 2531655
• DOI: http://doi.org/10.7461/jcen.2022.E2021.07.012

Abstract

Objective
Cerebral venous thrombosis (CVT) is a rare pathology with life threatening consequences, most of these fatal complications are due to raised intracranial pressure due to venous infarction and cerebral swelling, the purpose of this study is to evaluate the efficiency of decompressive craniectomy for favorable outcome.
Methods
A retrospective analysis of clinical, radiological and surgical data of patients who underwent decompressive craniectomy for CVT in a tertiary referral hospital between the years 2016 through 2020.
Results
The study included 7 patients, female predominance was noted (5/7), mean age was 18.14 years. Mean Glasgow coma score (GCS) at surgery was 8.26, good clinical outcome was achieved for the majority of cases 71.4%, and one case of mortality 14.28%.
Conclusions
Decompressive craniectomy is a life saving procedure for patients with severe brain swelling as a sequela of CVT, majority of patients (71.4%) showed favorable functional outcome by 6 months postoperatively.

Keyword

Dural sinus; Decompressive craniectomy; Cerebral venous thrombosis

Figure

• 

  Fig. 1. Twenty-three years old female patient, presented to emergency room with disturbed conscious level and seizures, GCS on presentation was 10. CT brain showed hemorrhagic infarction with mass effect and midline shift of 8 mm (A), MRI with contrast showed filling defect in right transverse sinus (red arrow) (B). Decompressive craniectomy was performed, immediate follow up radiology showed sufficient decompression and improvement of midline shift (C and D). GCS, Glasgow coma score; CT, computed tomography; MRI, magnetic resonance imaging

• 

  Fig. 2. Three years old male child’s MRI showing welling of the right temporal lobe and herniation (A), MRV showed thrombosis of right transverse sinus and vein of Labbe (B), decompressive craniectomy was performed which was tailored more towards temporal bone, two weeks follow up CT scan showing improvement of midline shift with residual increased CSF tension in subcutaneous collection (C), and the corresponding clinical follow up where patient was fully conscious with no deficit (GOS 5) (D). Six weeks follow up CT scan showing improvement of mass effect and midline shift with resolution of all increased tension signs (E). MRI, magnetic resonance imaging; MRV, MRI venogram; CT, computed tomography; CSF, cerebrospinal fluid; GOS, Glasgow outcome scale

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