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Decompressive craniectomy in cerebral venous thrombosis: a single centre experience

Aaron, Sanjith ; Alexander, Mathew ; Moorthy, Ranjith K ; Mani, Sunithi ; Mathew, Vivek ; Patil, Anil Kumar B ; Sivadasan, Ajith ; Nair, Shalini ; Joseph, Mathew ; Thomas, Maya ; Prabhu, Krishna ; Joseph, Baylis Vivek ; Rajshekhar, Vedantam ; Chacko, Ari George

Journal of neurology, neurosurgery and psychiatry, 2013-09, Vol.84 (9), p.995-1000 [Periódico revisado por pares]

England: BMJ Publishing Group Ltd

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Título:
Decompressive craniectomy in cerebral venous thrombosis: a single centre experience
Autor: Aaron, Sanjith ; Alexander, Mathew ; Moorthy, Ranjith K ; Mani, Sunithi ; Mathew, Vivek ; Patil, Anil Kumar B ; Sivadasan, Ajith ; Nair, Shalini ; Joseph, Mathew ; Thomas, Maya ; Prabhu, Krishna ; Joseph, Baylis Vivek ; Rajshekhar, Vedantam ; Chacko, Ari George
Assuntos: Adult ; Cerebral Infarction - pathology ; Decompressive Craniectomy - methods ; Decompressive Craniectomy - mortality ; Female ; Follow-Up Studies ; Functional Laterality - physiology ; Glasgow Coma Scale ; Humans ; Image Processing, Computer-Assisted ; Intracranial Thrombosis - diagnostic imaging ; Intracranial Thrombosis - mortality ; Intracranial Thrombosis - surgery ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Postoperative Care ; Postoperative Complications - epidemiology ; Postoperative Complications - therapy ; Radiography ; Retrospective Studies ; SINUS THROMBOSIS ; Stroke - surgery ; SURGERY ; Surgical Flaps ; Survival Analysis ; Treatment Outcome ; Venous Thrombosis - diagnostic imaging ; Venous Thrombosis - mortality ; Venous Thrombosis - surgery ; Young Adult
É parte de: Journal of neurology, neurosurgery and psychiatry, 2013-09, Vol.84 (9), p.995-1000
Notas: ArticleID:jnnp-2012-303356
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Descrição: Background Cerebral venous thrombosis (CVT) is an important cause for stroke in the young where the role for decompressive craniectomy is not well established. Objective To analyse the outcome of CVT patients treated with decompressive craniectomy. Methods Clinical and imaging features, preoperative findings and long-term outcome of patients with CVT who underwent decompressive craniectomy were analysed. Results Over 10 years (2002–2011), 44/587 (7.4%) patients with CVT underwent decompressive craniectomy. Diagnosis of CVT was based on magnetic resonance venography (MRV)/inferior vena cava (IVC). Decision for surgery was taken at admission in 19/44 (43%), within 12 h in 5/44 (11%), within first 48 h in 15/44 (34%) and beyond 48 h in 10/44 (22%). Presence of midline shift of ≥10 mm (p<0.0009) and large infarct volume (mean 146.63 ml; SD 52.459, p<0.001) on the baseline scan influenced the decision for immediate surgery. Hemicraniectomy was done in 38/44 (86%) and bifrontal craniectomy in 6/44 (13.6%). Mortality was 9/44 (20%). On multivariate analysis (5% level of significance) age <40 years and surgery within 12 h significantly increased survival. Mean follow-up was 25.5 months (range 3–66 months), 26/35 (74%) had 1 year follow-up. Modified Rankin Scale (mRs) continued to improve even after 6 months with 27/35 (77%) of survivors achieving mRs of ≤2. Conclusions This is the largest series on decompressive craniectomy for CVT in literature to date. Decompressive craniotomy should be considered as a treatment option in large venous infarcts. Very good outcomes can be expected especially if done early and in those below 40 years.
Editor: England: BMJ Publishing Group Ltd
Idioma: Inglês

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Decompressive craniectomy in cerebral venous thrombosis: a single centre experience

Aaron, Sanjith ; Alexander, Mathew ; Moorthy, Ranjith K ; Mani, Sunithi ; Mathew, Vivek ; Patil, Anil Kumar B ; Sivadasan, Ajith ; Nair, Shalini ; Joseph, Mathew ; Thomas, Maya ; Prabhu, Krishna ; Joseph, Baylis Vivek ; Rajshekhar, Vedantam ; Chacko, Ari George

England: BMJ Publishing Group Ltd

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