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Outcomes of Decompressive Surgery for Patients With Severe Cerebral Venous Thrombosis: DECOMPRESS2 Observational

Sanjit Aaron1, Jorge M Ferreira2, Jonathan M Coutinho3

  • 1Neurology Unit, Department of Neurological Sciences, Christian Medical College and Hospital, Vellore, Tamil Nadu, India (S.A., P.K., P.S.).

Stroke
|April 4, 2024
PubMed

Insights

Decompressive neurosurgery for cerebral venous thrombosis (CVT) shows promising long-term outcomes. Two-thirds of severe CVT patients survived one year post-surgery, with over a third regaining independence.

Area of Science:

  • Neurosurgery
  • Neurology
  • Vascular Neurology

Background:

  • Decompressive neurosurgery is recommended for severe cerebral venous thrombosis (CVT) with impending brain herniation, but evidence is limited.
  • This study reports long-term outcomes of CVT patients undergoing decompressive neurosurgery in an international cohort.

Purpose of the Study:

  • To evaluate the long-term outcomes of decompressive neurosurgery in patients with cerebral venous thrombosis (CVT).
  • To assess the association between baseline variables and patient outcomes after decompressive surgery for CVT.

Main Methods:

  • Prospective, international cohort study (DECOMPRESS2) of consecutive CVT patients treated with decompressive neurosurgery.
  • Evaluation at admission, discharge, 6 months, and 12 months using the modified Rankin Scale (mRS).
  • Multivariable logistic regression used to identify predictors of death or severe disability (mRS 5-6) at 12 months.

Main Results:

  • 118 patients (80 women, median age 38) from 10 countries were included.
  • At 12 months, 39% of patients were dead or severely disabled (mRS 5-6), while 35.6% were independent (mRS 0-2).
  • Coma and fixed dilated pupils were predictors of death or severe disability. 79% of survivors and 87% of caregivers viewed surgery positively.

Conclusions:

  • Decompressive surgery for severe CVT resulted in survival for two-thirds of patients and independence for over one-third at one year.
  • The positive opinions of patients and caregivers suggest surgery is worthwhile.
  • These findings support the use of decompressive neurosurgery for CVT patients with impending brain herniation.
Abstract

Keywords:
braincaregivershemorrhageischemic strokestroke

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