Clinical Characteristics and Mortality of Neurocritical Care Patients With Post-traumatic Cerebral Venous Outflow...

The clinical characteristics and natural history of post-traumatic cerebral venous outflow compromise (VOC) are poorly characterized. We aimed to determine the prevalence of VOC in at-risk traumatic brain injury patients, assess its effect on long-term mortality, and describe our management practices.

We conducted a retrospective single-center case-control study. We included patients admitted to the neurocritical care unit after traumatic brain injury who had been investigated with computed tomography venography because of clinical suspicion of VOC between 2008 and 2015.

A total of 89 patients underwent computed tomography venography during their neurocritical care unit admission. A total of 43 patients (48%, 32 male [74%], mean age 40 years [SD 16.2]) had evidence of VOC. Of these, 28 (65%) were due to an intraluminal dural venous sinus thrombosis (DVST) and 15 (35%) due to an extraluminal cause. Twelve (43%) of the DVSTs were occlusive, and 16 (57%) were nonocclusive. A total of 24 patients (27%) underwent decompressive craniectomy, which was more commonly performed for patients with an occlusive thrombosis than those with partial or no VOC (67% vs 23% vs 20%, P < .01). A total of 4 patients (14%) with an intraluminal thrombosis received antithrombotic therapy. Mortality rate of those with VOC may have been higher compared with those without VOC at 14 days (14% vs 7%, P = .31) but was similar at 5 years (21% vs 22%, P = .93). Patients with a midline or bilateral thrombosis had higher overall mortality (83% vs 18%, P = .01) than those with a thrombosis located elsewhere.

Among those at risk, patients with evidence of post-traumatic VOC may have had higher short-term mortality, but VOCs did not increase long-term mortality rates compared with those without VOC. Patients with an occlusive thrombosis were more likely to undergo decompressive craniectomy. Most patients with a DVST received prophylactic rather than treatment-dose antithrombosis. Further studies are required to determine the optimal management of post-traumatic VOC.