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The role of decompressive craniectomy in cerebral venous sinus thrombosis

Thanga Thirupathi Rajan Vivakaran1, Dwarakanath Srinivas, Girish Baburao Kulkarni

  • 1Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India.

Journal of Neurosurgery
|August 28, 2012
PubMed

Insights

Decompressive craniectomy is effective for selected cerebral venous sinus thrombosis (CVST) patients, with most achieving good outcomes. Postoperative Glasgow Coma Scale scores independently predict patient prognosis.

Area of Science:

  • Neurosurgery
  • Neurology
  • Critical Care Medicine

Background:

  • Cerebral venous sinus thrombosis (CVST) is a rare but serious condition.
  • Limited literature exists on decompressive craniectomy for CVST, with ethical concerns hindering randomized trials.

Purpose of the Study:

  • To evaluate the efficacy and outcomes of decompressive craniectomy in a cohort of patients with CVST.
  • To review existing literature on this surgical intervention for CVST.

Main Methods:

  • Retrospective analysis of 34 patients undergoing decompressive craniectomy for CVST (August 2006 - June 2008).
  • Evaluation of demographic, clinicoradiological, and operative findings.
  • Assessment of surgical outcomes using the Glasgow Outcome Scale (GOS) and Rankin Disability Scale.

Main Results:

  • A total of 34 patients (13 male, 21 female; mean age 31.6 years) were included.
  • Preoperative and postoperative Glasgow Coma Scale (GCS) scores significantly correlated with poor outcomes.
  • Postoperative GCS score was the sole independent predictor of poor outcome in multivariate analysis.

Conclusions:

  • Decompressive craniectomy demonstrated good outcomes in the majority (26/34) of selected CVST patients (GOS score 4 or 5).
  • This study represents the largest series on decompressive craniectomy for CVST in the literature.
  • The authors recommend considering decompressive craniectomy for carefully selected CVST patients.
Abstract

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