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Shunting in acute cerebral venous thrombosis: a systematic review

S Lobo1, J M Ferro, F Barinagarrementeria

  • 1Department of Neurosciences (Neurology), Hospital de Santa Maria, University of Lisbon, Lisbon, Portugal.

Cerebrovascular Diseases (Basel, Switzerland)
|December 21, 2013
PubMed

Insights

Cerebrospinal fluid shunting in acute cerebral venous thrombosis (CVT) shows limited efficacy, with only half of patients regaining independence and a quarter dying. Shunting may benefit select patients with sustained intracranial hypertension but no parenchymal lesions.

Area of Science:

  • Neurology
  • Neurosurgery
  • Vascular Neurology

Background:

  • Acute cerebral venous thrombosis (CVT) poses a risk of intracranial hypertension and fatal brain herniation.
  • The effectiveness of cerebrospinal fluid (CSF) shunting in managing these complications in CVT is not well-established.

Purpose of the Study:

  • To evaluate the efficacy of CSF shunting in treating acute CVT patients.
  • To determine if shunting reduces intracranial hypertension and prevents brain herniation in acute CVT.

Main Methods:

  • A systematic review and analysis of patients from the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT) treated with shunting.
  • Outcome assessment at 6 months and final follow-up using the modified Rankin Scale (mRS).

Main Results:

  • Fifteen patients received shunting (6 external ventricular drain, 8 ventriculoperitoneal).
  • 53.3% achieved independence (mRS 0-2), 13.3% had severe disability (mRS 4-6), and 26.7% died.
  • Patients with intracranial hypertension and no parenchymal lesions treated later than 48 hours with a ventriculoperitoneal shunt showed favorable outcomes.

Conclusions:

  • Shunting in acute CVT has a high mortality rate (26.7%) and limited success in achieving independence (53.3%).
  • Current evidence suggests shunting may not be effective in preventing herniation in acute CVT.
  • Shunting might offer benefits for specific patient subgroups with sustained intracranial hypertension and no parenchymal lesions.
Abstract

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