May 2024 Stroke Highlights

Aaron and colleagues evaluated the role of decompressive craniectomy or hematoma evacuation as a life-saving procedure in patients with cerebral venous thrombosis and acute stroke (large infarct or hemorrhages) and impending herniation.The study was based on data from an international prospective multicenter cohort study.The outcomes included modified Rankin Scale score, mortality, and patient-reported outcomes at 6 and 12 months.Of the 118 patients included, 31% presented with coma and 18% with unilateral or bilateral fixed pupils concerning for transtentorial herniation.Before surgery, 70% of patients had neurological worsening, with comatose patients increasing to 59%.Imaging preceding the surgery confirmed worsening findings in more than half of the patients.Surgical procedures were performed a median of 1 day after admission and 1 day after diagnosis.Most procedures (98%) were hemicraniectomies, bilateral in 7%, and of the posterior fossa in 2%.Medical complications were common, and 15% of patients required reintervention to relieve increased intracranial pressure.Mortality was 24% during acute hospitalization, increasing to 32% at 6 months and 34% at 12 months.Severe disability (modified Rankin Scale scores, 4-5) was 14% at 6 months and 9% at 12 months.Full recovery (modified Rankin Scale scores, 0-1) rose from 12% at 6 months to 16.1% at 12 months.Various prognostic factors were identified, with older age being a major one associated with a higher risk of adverse outcomes.This study highlights the high mortality and morbidity of severe cerebral venous thrombosis and suggests that select patients may benefit from early surgical intervention.See p 1218.