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

Neurologia (Engl Ed)

Stroke Clinic, Instituto Nacional de Neurología and Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico.

Published: November 2023

AI Article Synopsis

  • Mortality in cerebral venous thrombosis (CVT) is about 2%, and decompressive craniectomy (DC) may be crucial for patient survival despite this favorable prognosis.
  • A study analyzed 26 patients, mostly female, showing that a significant majority had acute CVT with neurological symptoms and large venous infarctions on imaging.
  • Findings indicated a higher mortality rate (42.3%) during hospitalization, but for those who survived, DC offered a potentially acceptable functional outcome.

Article Abstract

Introduction: Despite the highly favorable prognosis, mortality occurs in nearly 2% of patients with cerebral venous thrombosis (CVT), in which decompressive craniectomy (DC) may be the only way to save the patient's life. The aim of this report is to describe the risk factors, neuroimaging features, in-hospital complications and functional outcome of severe CVT in patients treated with DC.

Materials And Methods: Consecutive malignant CVT cases treated with DC from a retrospective third-level hospital database were analyzed. Demographic, clinical, and functional outcomes were analyzed.

Results: Twenty-six patients were included (20 female, age 35.4±12.1 years); 53.8% of the patients had acute CVT, with neurological focalization as the most common symptom in 92.3% of the patients. Superior sagittal sinus thromboses were found in 84.6% of cases. Bilateral lesions were present in 10 patients (38.5%). Imaging on admission showed a parenchymal lesion (venous infarction±hemorrhagic lesion)>6cm measured along the longest diameter in 25 patients (96.2%). Mean duration of clinical neurological deterioration was 3.5 days; eleven patients (42.3%) died during hospitalization.

Conclusion: In patients with severe forms of CVT, we found higher mortality than previously reported. DC is an effective life-saving treatment with acceptable functional prognosis for survivors.

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Source
http://dx.doi.org/10.1016/j.nrleng.2021.04.009DOI Listing

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