A BSTRACT Introduction: Cerebral venous sinus thrombosis (CVST) is a venous stroke caused by dural venous sinuses blockage which leads to infarction of the draining brain parenchyma. This pathology is rare in the older age group and commonly occurs in the young age group between 20 and 35 years. Unlike arterial strokes, where decompressive craniectomy is widely accepted, its use in patients with venous strokes like CVST has not been widely adopted. Therefore, the aim of this study is to assess the role of decompressive craniotomy as a treatment approach for CVST. Objective: The objective of the study was to evaluate the role and effectiveness of surgical decompression in the management of CVST. Materials and Methods: A retrospective observational study of clinical, radiological, surgical and long-term follow-up data from patients who underwent surgical decompression for CVST in a tertiary centre from 2014 to 2023. Results: Over a period of 9 years, a total of 24 patients of CVST underwent surgical decompression with a female preponderance noted. The most common presentation was headache, and the commonly involved sinus was the superior sagittal sinus. The decision of surgical decompression in 20 patients was made within 24 h of admission. Mean follow-up was 14 months (range 12–28 months) with 16 patients had more than 1 year of follow-up. Modified Rankin Scale (mRs) shows good clinical recovery during the follow-up period. Conclusion: The prognosis depends on how early the treatment is initiated, the Glasgow Coma Scale at presentation, the area of brain damaged and associated prothrombotic conditions. The radiological picture appears more aggressive compared to the clinical status, and hence, a significant number of patients can be managed medically. Even though medical management is the treatment of choice, certain red flags should be identified early, and timely intervention in the form of surgical decompression in a patient with a malignant venous infarct with impending brain herniation should be considered. We feel that the timing of surgery is critical in improving outcomes.
Joshi et al. (Sat,) studied this question.