Decompressive Surgery in Cerebrovenous Thrombosis

Ferro, José M.; Crassard, Isabelle; Coutinho, Jonathan M.; Canhão, Patrı́cia; Barinagarrementería, Fernando; Cucchiara, Brett; Derex, Laurent; Lichy, Christoph; Masjuán, Jaime; Massaro, Ayrton Roberto; Matamala, Gonzalo; Poli, Sven; Saadatnia, Mohammad; Stolz, Erwin; Viana-Baptista, Miguel; Stam, Jan; Bousser, Marie‐Germaine; Investigators, Dural Sinus Thrombosis (Iscvt )

doi:10.1161/strokeaha.111.615393

Cited by 196 publications

(92 citation statements)

References 22 publications

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“…The introduction of anticoagulation and later decompressive hemicraniectomy probably had a positive effect on the survival of patients. 13,14 Unfortunately, we could not extract individual patient data from the studies and thus were unable to correlate data on mortality or hemorrhagic complications to the different types of heparin.…”

Section: Discussionmentioning

confidence: 99%

Declining Mortality in Cerebral Venous Thrombosis

Coutinho

Zuurbier

Stam

2014

Stroke

Self Cite

163

104

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We extracted data on study design, demographics, baseline clinical manifestations, risk factors, ancillary investigations, treatment, and Background and Purpose-Cerebral venous thrombosis (CVT) is nowadays considered a disease with a good outcome in most cases, but in the past, these patients were thought to have a grave prognosis. We systematically studied the apparent decline in mortality of patients with CVT over time. Methods-A systematic review of the literature (MEDLINE and EMBASE) was performed. Studies with ≥40 patients with CVT that reported mortality at discharge or follow-up were eligible. Duplicate publications based on the same patient cohort were excluded. Studies were ranked according to the year halfway the period of patient inclusion. Two of the authors independently screened all eligible studies. Results-We screened 4585 potentially eligible studies, of which 74 fulfilled the selection criteria. The number of patients per study varied from 40 to 706 (median, 76). Data from 8829 patients with CVT, included from 1942 to 2012, were analyzed. The average age was 32.9 years, and 64.7% were women. There was a significant inverse correlation between mortality and year of patient recruitment (Pearson correlation coefficient, −0.72; P<0.001). In a sensitivity analysis, the correlation remained significant after exclusion of studies published before 1990, retrospective studies, or single-center studies. Both the frequency of focal neurological deficits and coma also decreased significantly over time (correlation coefficient, −0.50 and −0.52). Conclusions-There is a clear trend in declining mortality among patients with CVT over time. Possible explanations are improvements in treatment, a shift in risk factors, and, most importantly, the identification of less severe cases by improved diagnostic methods.

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Section: Discussionmentioning

confidence: 99%

Declining Mortality in Cerebral Venous Thrombosis

Coutinho

Zuurbier

Stam

2014

Stroke

Self Cite

163

104

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“…Good outcome was defined as modified Rankin Scale of 0 to 4 according to the pooled analysis of 3 randomized trials in patients with malignant middle cerebral artery infarction and 1 in CSVT. 1,4 Complications were categorized as: (1) related to the DC, (2) related to cranioplasty, and (3) medical complications. Infections, excessive blood loss, and hematomas confined to the surgical field were graded as surgical complications.…”

Section: Outcomementioning

confidence: 99%

Decompressive Hemicraniectomy in Patients With Supratentorial Intracerebral Hemorrhage

Fung

Murek

Z'Graggen

et al. 2012

Stroke

157

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Background and Purpose— Decompressive craniectomy (DC) lowers intracranial pressure and improves outcome in patients with malignant middle cerebral artery stroke. Its usefulness in intracerebral hemorrhage (ICH) is unclear. The aim of this study was to analyze feasibility and safety of DC without clot evacuation in ICH. Methods— We compared consecutive patients (November 2010–January 2012) with supratentorial ICH treated with DC without hematoma evacuation and matched controls treated by best medical treatment. DC measured at least 150mm and included opening of the dura. We analyzed clinical (age, sex, pathogenesis, Glasgow Coma Scale, National Institutes of Health Stroke Scale), radiological (signs of herniation, side and size of hematoma, midline shift, hematoma expansion, distance to surface), and surgical (time to and indication for surgery) characteristics. Outcome at 6 months was dichotomized into good (modified Rankin Scale 0–4) and poor (modified Rankin Scale 5–6). Results— Twelve patients (median age 48 years; interquartile range 35–58) with ICH were treated by DC. Median hematoma volume was 61.3mL (interquartile range 37–83.5mL) and median preoperative Glasgow Coma Scale was 8 (interquartile range 4.3–10). Four patients showed signs of herniation. Nine patients had good and 3 had poor outcomes. Three patients (25%) of the treatment group died versus 8 of 15 (53%) of the control group. There were 3 manageable complications related to DC. Conclusions— DC is feasible in patients with ICH. Based on this small cohort, DC may reduce mortality. Larger prospective cohorts are warranted to assess safety and efficacy.

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“…In a review of 69 patients who had decompressive hemicraniectomy for impending herniation in the setting of CVST, 26 patients (37.7%) had complete recovery (modified Rankin Scale score 0-1) while 15 patients (21.7%) were dead or severely disabled (modified Rankin Scale score 4-6) after 12 months median follow-up. 8 In our patient, since her level of arousal improved with anticoagulation alone, endovascular therapy was not pursued.…”

Section: Sectionmentioning

confidence: 87%