Decompressive craniectomy in cerebral venous thrombosis: a single centre experience

Area of Science:

• Neurosurgery
• Neurology
• Vascular Neurology

Background:

• Cerebral venous thrombosis (CVT) is a significant cause of stroke in younger populations.
• The efficacy of decompressive craniectomy for CVT remains incompletely understood.

Purpose of the Study:

• To evaluate the outcomes of patients with CVT who underwent decompressive craniectomy.
• To identify factors influencing survival and functional recovery in CVT patients treated with decompressive craniectomy.

Main Methods:

• A retrospective analysis of 44 CVT patients who underwent decompressive craniectomy between 2002 and 2011.
• Clinical and imaging data, including midline shift and infarct volume, were analyzed.
• Outcomes were assessed using the modified Rankin Scale (mRs) with a mean follow-up of 25.5 months.

Main Results:

• Decompressive craniectomy was performed in 7.4% of CVT patients, with hemicraniectomy being the most common procedure (86%).
• Mortality was 20%, but multivariate analysis indicated that age under 40 and surgery within 12 hours were associated with significantly increased survival.
• Among survivors, 77% achieved a favorable outcome (mRs ≤ 2), with continued improvement noted even after six months.

Conclusions:

• Decompressive craniectomy is a valuable treatment option for CVT patients presenting with large venous infarcts.
• Early surgical intervention (within 12 hours) and treatment in younger patients (<40 years) are associated with better prognoses.
• This study represents the largest series on decompressive craniectomy for CVT, suggesting good outcomes are achievable with appropriate patient selection and timely treatment.