Decompressive craniectomy for malignant cerebral oedema of cortical venous thrombosis: an analysis of 13 patients

Abstract

Objective. The study aims to define the role and indication of surgical intervention in cases of malignant cerebral edema in consequence to cortical venous thrombosis (CVT).Methods. A retrospective study of 13 patients who underwent decompressive craniectomies for malignant CVT is presented. All patients had supra-tentorial cortical lesions attributable to CVT. The diagnosis was based on CT scan and MRI findings. Patients who presented in a poor clinical status with radiological evidence of malignant cerebral oedema as well as patients who worsened while on medical therapy underwent decompressive hemicraniectomies. Patients were followed up, and the outcome assessed as per Glasgow Outcome Scale (GOS) and Karnofsky Performance Status (KPS) scale.Results. There were nine females and four males with a mean age of 29.2 years. Eleven patients survived with good outcome (GOS = 5, n = 5; GOS = 4, n = 6). At the last follow-up (median 35 months; mean 39 months), the KPS scale was 90 for five, 80 for four and 70 for two survivors. There were two deaths, both in patients with pre-operative Glasgow Coma Scale (GCS) <5.Conclusion. Timely recognition of failure of medical management and an appropriately timed surgical intervention may help to salvage CVT patients who develop malignant cerebral oedema.