Decompression craniotomy for malignant cerebral venous thrombosis:a report of 9 cases / 中国脑血管病杂志

ABSTRACT

Objective To evaluate the efficacy of decompression craniotomy for the treatment of patients with malignant cerebral venous thrombosis. Methods The clinical characteristics,treatment process and follow - up results of 9 patients with malignant cerebral venous thrombosis treated with decom-pression craniotomy in Beijing Xuanwu Hospital,Capital Medical University from February 2010 to August 2015 were analyzed retrospectively. Results The preoperative Glasgow coma scale (GCS)score of 9 patients was < 9,7 survived and 2 died. The conditions of 6 patients (preoperative GCS 8 in 1 case, GCS 6 in 3cases,GCS 4 in 1case,and GCS3 in 1case)were improved in combination with other control intrac ranial pressure treatment after craniotomy decompression surgery. They recovered well (Glasgow outcome scale, GOS 4 -5). One patient (preoperative GCS 4)had severe disability (GOS 3)after procedure;1 (preoperative GCS 3)was in deep comatose state at the time of discharge and died of complications after 1 month;1 patient with bilateral mydriasis (GCS 5)was treated with craniotomy decompression,and his pupils did not return,he had circulatory failure,gave up the treatment,and died. All patients did not have the complications directly related to the surgery. Seven patients survived and continued to use warfarin anticoagulation therapy for at least 6 moths after discharge. The controlled international normalized ratio (INR)was 2 -3. They were followed up for 3 months to 5 years. The head MRI re-examination did not reveal the recurrence of venous sinus thrombosis. The modified Rankin scales (mRS)score was 0 to 2 in 6 cases after 3 months. The other one (preoperative GCS 4)had ipsilateral cerebral hemorrhage on surgical site at 4 months after discharge. He was improved after withdrawing anticoagulation and using conservative treatment for 20 d (mRS score 4). Conclusions For patients with malignant cerebral venous thrombosis,when the patients have acute cerebral hernia or hernia tendency,the emergency craniotomy decompression surgery may save lives and enable patients to achieve a better quality of life.