Decompressive Hemicraniectomy Versus Medical Management in Cerebral Venous Thrombosis with Signs of Raised Intracranial Pressure

  • Atulabh Vajpeyee Consultant Neurosurgeon, Department of Neurosurgery; Pacific Medical College & Hospital, Udaipur
  • Narendra Mal Consultant Neurosurgeon, Department of Neurosurgery; Pacific Medical College & Hospital, Udaipur
  • Ramakant Khan Consultant Neuro Intensivist, Department of Neuro Anesthesia Pacific Medical College & Hospital, Udaipur
  • Manisha Vajpeyee Director Scientific Research, Pacific Medical College & Hospital, Udaipur
Keywords: cerebral venous thrombosis, raised intracranial pressure, decompressive hemicraniectomy.

Abstract

Background: Mass effect is the major cause of death in cortical venous sinus thrombosis and there is no clear cut the role of decompressive hemicraniectomy. Aims: To study the outcome of patients with large venous infarct and acutely increased intracranial pressure subjected to either conservative treatment or decompressive surgery.

Materials & Methods: 20 consecutive patients admitted with moderate to large venous infarct were examined for features of raised intracranial pressure (ICP) . Cranial CT and or MRI and CT venogram or MR venogram and or cerebral DSA were examined for site of Sino venous occlusion.

Results: There were 20 patients with 10 each in conservatively and surgically treated group. Cranial CT/MRI head revealed large venous infarct with midline shift and mass effect in all patients. Overall 15 of 16 survivors had good outcome at 3 months without any significant residual deficit irrespective of mode of treatment used. There is no statistical difference between medical and surgical groups in mRS 1 month, 3 months and death with p value 0.651, 0.185 and 0.474 respectively.

Conclusion: Patient with large venous infarct with signs of raised intracranial pressure carries good overall outcome with timely care irrespective of conservative or surgical management.

 

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Published
2018-03-21
How to Cite
1.
Vajpeyee A, Mal N, Khan R, Vajpeyee M. Decompressive Hemicraniectomy Versus Medical Management in Cerebral Venous Thrombosis with Signs of Raised Intracranial Pressure. IABCR [Internet]. 21Mar.2018 [cited 11Dec.2018];4(1):170-3. Available from: https://iabcr.org/index.php/iabcr/article/view/300