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.


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.



Download data is not yet available.


1. Krayenbuhl H. Cerebral venous and sinus thrombosis. Clin Neurosurg. 1967;14:1–24.
2. Jourdan C, et al, Evaluation of the clinical benefit of decompression hemicraniectomy in intracranial hypertension not controlled by medical treatment Neurochirurgie 1993, 39:304-310.
3. Bousser MG, Chiras J, Bories J, Castaigne P. Cerebral venous thrombosis:a review of 38 cases. Stroke. 1985;16:199 –213.
4. Cantu C, Barinagarrementeria F. Cerebral venous thrombosis associated with pregnancy and puerperium: review of 67 cases. Stroke. 1993;24: 1880–1884.
5. deVeber G, Andrew M, Adams C, Bjornson B, Booth F, Buckley DJ, Camfield CS, David M, Humphreys P, Langevin P, MacDonald EA, Gillett J, Meaney B, Shevell M, Sinclair DB, Yager J; Canadian Pediatric Ischemic Stroke Study Group. Cerebral sinovenous thrombosis in childhood. N Engl J Med. 2001;345:417– 423.
6. Einhaupl KM, Masuhr F. Cerebral venous and sinus thrombosis: an update. Eur J Neurol. 1994;1:109 –126.
7. de Bruijn SFTM, de Haan RJ, Stam J; for the Cerebral Venous Sinus Thrombosis Study Group. Clinical features and prognostic factors of cerebral venous sinus thrombosis in a prospective series of 59 patients. J Neurol Neurosurg Psychiatry. 2001;70:105–108.
8. Ferro J, Correia M, Pontes C, Baptista M, Pita F (VENOPORT). Cerebral vein and dural sinus thrombosis in Portugal: 1980–1998. Cerebrovasc Dis. 2001;11:177–182.
9. Ferro JM, Lopes MG, Rosas MJ, Ferro MA, Fontes J; for the Cerebral Venous Thrombosis Portuguese Collaborative Study Group (VENOPORT). Long-term prognosis of cerebral vein and dural sinus thrombosis: results of the VENOPORT Study. Cerebrovasc Dis. 2002; 13:272–278.
10. Canhão P, José M. Ferro, Arne G. Lindgren, Marie-Germaine Bousser, Stam, Fernando. Causes and Predictors of Death in Cerebral Venous Thrombosis. Stroke 2005; 36; 1720-1725
11. Stefini R, Latronico N, Cornali C, Rasulo F, Bollati A. Emergent decompressive craniectomy in patients with fixed dilated pupils due to cerebral venous and dural sinus thrombosis: report of three cases. Neurosurgery. 1999;45:626 –30.
12. Einhaupl KM, Villringer A, Meister W, Mehraein S, Garner C, Pellkofer M, Haberl RL, Pfister HW, Schmiedek P. Heparin treatment in sinus venous thrombosis. Lancet. 1991; 338:597– 600.
13. Ferro JM, Canhao P, Stam J, Bousser MG, Barinagarrementeria F; ISCVT Investigators. Stroke. 2004 Mar; 35(3):664-70.
14. Rabinstein A. A., Mueller-Kronast N., Maramattom B. V., Zazulia A. R., Bamlet W. R., Diringer M. N. and Wijdicks E.F.M..Factors predicting prognosis after decompressive hemicraniectomy for hemispheric infarction Neurology 2006; 67;891-893
15. Ferro JM, et al, Decompressive surgery in cerebrovenous thrombosis, Stroke AHA, 2011,42, 2825-2831
16. Saposnik G, et al, Diagnosis and management of cerebral venous thrombosis, Stroke AHA, 2011
How to Cite
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 20Mar.2019];4(1):170-3. Available from: