403 Malignant Cerebral Venous Infarction: Decompressive Craniectomy Versus Medical Treatment

INTRODUCTION: Cerebral venous thrombosis (CVT) is a common stroke in young adults and is associated with 8% mortality. High intracranial pressure (ICP) and brain herniation are these patients' most common causes of death. METHODS: In this retrospective study, Patients with the following inclusion criteria have entered the study: 1) CVT proven by contrast-enhanced magnetic resonance venogram and/or computed tomography venogram, 2) malignant CVT (impending brain herniation according to imaging and clinical finding), and 3) age between 16 and 80 years. Patients with deep venous system thrombosis, Glasgow Coma Scale (GCS) score of 3, and bilateral nonreactive mid-position pupils or mydriasis on admission were excluded. Patients were classified into 2 groups: surgical group (DC group) including patients who received medical treatment and DC and medical group (MG) including patients who received only medical treatment. Outcomes and complications were assessed and compared between the 2 groups. RESULTS: Of 357 patients with CVT hospitalized in our center, 48 patients entered the study. 23 patients were managed medically, and 25 patients were managed surgically. There was no significant difference between the groups concerning age, sex, presenting symptoms, transient and permanent risk factors of CVT, GCS score on admission, and pupils’ reactivity on admission. All patients in the MG died during hospitalization in comparison with 8 patients in the DC group (100% vs. 32%, P < 0.001). A favorable outcome (modified Rankin scale score 0e2) was achieved in 52% of the DC group and 0% of the MG group (P < 0.001). CONCLUSIONS: Our study confirmed that in contrast with DC, medical treatment could not prevent transtentorial herniation. DC is not only lifesaving for patients with CVT with impending brain herniation but also results in favorable outcomes in most patients.