Role of Decompressive Craniectomy in the Management of Cerebral Venous Sinus Thrombosis
Cerebral venous sinus thrombosis (CVST) is a relatively uncommon cause of stroke more often affecting women and younger individuals. Blockage of the venous outflow rapidly causes edema and space-occupying venous infarctions and it seems intuitive that decompressive craniectomy (DC) can effectively r...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2019-05-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/article/10.3389/fneur.2019.00511/full |
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| author | Raghunath Avanali M. S. Gopalakrishnan B. Indira Devi B. Indira Devi Dhananjaya I. Bhat Dhaval P. Shukla Nagesh C. Shanbhag |
| author_facet | Raghunath Avanali M. S. Gopalakrishnan B. Indira Devi B. Indira Devi Dhananjaya I. Bhat Dhaval P. Shukla Nagesh C. Shanbhag |
| author_sort | Raghunath Avanali |
| collection | DOAJ |
| description | Cerebral venous sinus thrombosis (CVST) is a relatively uncommon cause of stroke more often affecting women and younger individuals. Blockage of the venous outflow rapidly causes edema and space-occupying venous infarctions and it seems intuitive that decompressive craniectomy (DC) can effectively reduce intracranial pressure just like it works for malignant middle cerebral artery infarcts and traumatic brain injury. But because of the relative rarity of this type of stroke, strong evidence from randomized controlled trials that DC is a life-saving procedure is not available unlike in the latter two conditions. There is a possibility that other forms of interventions like endovascular recanalization, thrombectomy, thrombolysis, and anticoagulation, which cannot be used in established middle cerebral artery infarcts and TBI, can reverse the ongoing pathology of increasing edema in CVST. Such interventions, although presently unproven, could theoretically obviate the need for DC when used in early stages. However, in the absence of such evidence, we recommend that DC be considered early as a life-saving measure whenever there are large hemorrhagic infarcts, expanding edema, radiological, and clinical features of impending herniation. This review gives an overview of the etiology and risk factors of CVST in different patient populations and examines the effectiveness of DC and other forms of interventions. |
| first_indexed | 2024-12-19T13:54:11Z |
| format | Article |
| id | doaj.art-08ca0c0b23d74af79ee75c87d8c12aa0 |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-12-19T13:54:11Z |
| publishDate | 2019-05-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj.art-08ca0c0b23d74af79ee75c87d8c12aa02022-12-21T20:18:38ZengFrontiers Media S.A.Frontiers in Neurology1664-22952019-05-011010.3389/fneur.2019.00511418579Role of Decompressive Craniectomy in the Management of Cerebral Venous Sinus ThrombosisRaghunath Avanali0M. S. Gopalakrishnan1B. Indira Devi2B. Indira Devi3Dhananjaya I. Bhat4Dhaval P. Shukla5Nagesh C. Shanbhag6Department of Neurosurgery, Government T. D. College, Allapuzha, IndiaDepartment of Neurosurgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, IndiaDepartment of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, IndiaNIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United KingdomDepartment of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, IndiaDepartment of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, IndiaDepartment of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, IndiaCerebral venous sinus thrombosis (CVST) is a relatively uncommon cause of stroke more often affecting women and younger individuals. Blockage of the venous outflow rapidly causes edema and space-occupying venous infarctions and it seems intuitive that decompressive craniectomy (DC) can effectively reduce intracranial pressure just like it works for malignant middle cerebral artery infarcts and traumatic brain injury. But because of the relative rarity of this type of stroke, strong evidence from randomized controlled trials that DC is a life-saving procedure is not available unlike in the latter two conditions. There is a possibility that other forms of interventions like endovascular recanalization, thrombectomy, thrombolysis, and anticoagulation, which cannot be used in established middle cerebral artery infarcts and TBI, can reverse the ongoing pathology of increasing edema in CVST. Such interventions, although presently unproven, could theoretically obviate the need for DC when used in early stages. However, in the absence of such evidence, we recommend that DC be considered early as a life-saving measure whenever there are large hemorrhagic infarcts, expanding edema, radiological, and clinical features of impending herniation. This review gives an overview of the etiology and risk factors of CVST in different patient populations and examines the effectiveness of DC and other forms of interventions.https://www.frontiersin.org/article/10.3389/fneur.2019.00511/fullanticoagulationcerebral venous sinus thrombosisdecompressive craniectomyoutcomerisk factors |
| spellingShingle | Raghunath Avanali M. S. Gopalakrishnan B. Indira Devi B. Indira Devi Dhananjaya I. Bhat Dhaval P. Shukla Nagesh C. Shanbhag Role of Decompressive Craniectomy in the Management of Cerebral Venous Sinus Thrombosis Frontiers in Neurology anticoagulation cerebral venous sinus thrombosis decompressive craniectomy outcome risk factors |
| title | Role of Decompressive Craniectomy in the Management of Cerebral Venous Sinus Thrombosis |
| title_full | Role of Decompressive Craniectomy in the Management of Cerebral Venous Sinus Thrombosis |
| title_fullStr | Role of Decompressive Craniectomy in the Management of Cerebral Venous Sinus Thrombosis |
| title_full_unstemmed | Role of Decompressive Craniectomy in the Management of Cerebral Venous Sinus Thrombosis |
| title_short | Role of Decompressive Craniectomy in the Management of Cerebral Venous Sinus Thrombosis |
| title_sort | role of decompressive craniectomy in the management of cerebral venous sinus thrombosis |
| topic | anticoagulation cerebral venous sinus thrombosis decompressive craniectomy outcome risk factors |
| url | https://www.frontiersin.org/article/10.3389/fneur.2019.00511/full |
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