Abstract Details

Title Decompressive Craniectomy in Patients with Severe Cerebral Venous Sinus Thrombosis

Topic Neuro Trauma and Critical Care

Presentation(s) P1 - Poster Session 1 (9:00 AM-5:00 PM)

Poster/Presentation
Number 368

Objective To investigate the effect of decompressive craniectomy on survival in rapidly deteriorating patients with severe cerebral venous sinus thrombosis (CVST).

Background CVST is a rare neurological disease with a multitude of etiologies and risk factors. Owing to the rarity of CVST, little is known about the role of decompressive craniectomy in patients with severe CVST.

Design/Methods A retrospective cohort study was conducted to include patients hospitalized with malignant CVST between 1997 and 2017 at the Brigham and Women’s Hospital (BWH) and Massachusetts General Hospital (MGH). Three search tiers were employed to define the encounter, surgical intervention and signs/symptoms of severe CVST. Patients younger than 18 years-old and those with traumatic brain injury, stroke and tumors were excluded. Binary logistic regression was used to assess association between different variables and outcomes, with multi-variate fitting to assess for independent association.

Results We identified a total of fourteen patients (28.6% males, 71.4% females). Mean age was 48.0 (+/- 17.3) years-old. Mean GCS before surgery was 7.5 (+/- 3.5). Transverse sinus was most commonly involved (n=10) followed by sigmoid sinus (n=9). Twelve patients had any intracranial hemorrhage. Immediately before surgery, the mean ICH volume was 45.0 ml (+/- 41.7), mean volume of mass-effect was 104.4 ml (+/- 44.2), mean midline-shift at pineal gland was 6.6mm (+/- 3.6), and mean midline-shift at the cranial-most portion of corpus callosum was 7.9mm (+/- 6.4). Ten patients were anti-coagulated upon presentation. Thrombosis in superior sagittal sinus correlated with unfavorable outcomes (p=0.036). Four patients expired and eight patients had a favorable outcome at last known follow-up.

Conclusions Patients with severe CVST are at risk of fatal outcomes. Craniectomy led to favorable outcomes in more than half of the patients in our cohort. Large-scale studies are warranted to further investigate the role of decompressive craniectomy in patients with CVST.

Authors/Disclosures
Hadi Abou-El-Hassan, MD PRESENTER	Dr. Abou-El-Hassan has nothing to disclose.
	No disclosure on file
Saef Izzy, MD, FAAN (Brigham and Women'S Hospital, Harvard Medical School)	The institution of Dr. Izzy has received research support from NINDS. The institution of Dr. Izzy has received research support from The Gillian Reny Stepping Strong Center for Trauma Innovation. Dr. Izzy has received publishing royalties from a publication relating to health care.
Ayaz M. Khawaja, MD	Dr. Khawaja has nothing to disclose.

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