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04-08-2011 | Article

Decompressive surgery ‘lifesaving’ in cerebral venous thrombosis


Free abstract

MedWire News: Decompressive surgery can be lifesaving for patients with cerebral venous thrombosis (CVT) with lesions causing mass effect, even if they have very severe symptoms, show data from a multinational registry.

Just 4% of CVT patients die in the acute phase, say José Ferro (Hospital Santa Maria, Lisbon, Portugal) and colleagues. Such deaths are generally caused by herniation resulting from large edematous venous infarctions or parenchymal hemorrhages.

The team analyzed data from 38 patients in a registry covering 22 centers, as well as 31 patients identified in a literature review - a total of 69 patients. Seven patients underwent hematoma evacuation, 45 had decompressive craniectomy, and 17 had both interventions.

At a median of 12 months after surgery, just 17.4% of patients had an unfavorable outcome, defined as death or a modified Rankin Scale (mRS) score of 5 (very severely disabled).

In all, 37.7% of patients achieved complete recovery (mRS 0-1), and 56.5% were functionally independent (mRS 0-2). A further 5.8% were alive but severely disabled (mRS 4-5), and 15.9% died.

The researchers note that these outcomes are better than those reported for stroke patients with space-occupying infarcts who undergo decompressive craniectomy.

"The encouraging results we observed reflect the overall good survival and functional outcome of patients with CVT, once acute death attributable to cerebral herniation is prevented," they comment in the journal Stroke.

Patients who were comatose at presentation (Glasgow Coma Scale <9) were less likely to achieve functional independence than were those with less severe brain injury, at 44.9% versus 84.2%. Also, patients with bilateral parenchymal lesions were more likely to die than those with unilateral lesions, at 41.7% versus 10.5%.

Yet 34.7% of comatose patients and 33.3% of those with bilateral lesions made a complete recovery after surgery, as did 33.3% of patients with bilateral fixed, dilated pupils.

"These results encourage the use of decompressive surgery as a lifesaving procedure in selected CVT patients," conclude Ferro et al.

"A severe neurological condition, such as coma, bilateral fixed pupils, or bilateral lesions, should not discourage surgery, because at least one-third of such patients can have a good recovery."

By Eleanor McDermid