Bilateral Decompressive Craniectomy in Malignant Cerebral Venous Thrombosis

Authors

• Eduardo Soriano-Navarro Stroke Clinic, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, Mexico
• Vanessa Cano-Nigenda Stroke Clinic, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, Mexico
• Fernanda Menéndez-Manjarrez Stroke Clinic, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez
• Esmirna Farington-Terrero Stroke Clinic, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, Mexico
• Juan José Méndez-Gallardo Stroke Clinic, Endovascular Stroke Therapy, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, Mexico
• Alejandro García-Irigoyen Stroke Clinic, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, Mexico
• Antonio Arauz Stroke Clinic, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, Mexico

antonio.arauz@prodigy.net.mx

Keywords

Abstract

Introduction: Despite the extremely favourable prognosis of patients with cerebral venous thrombosis (CVT), death occurs in 10–15% of patients. In severe cases of malignant CVT with supratentorial haemorrhagic lesions, cerebral oedema and brain herniation, decompressive surgery may be the only life-saving treatment.
Patient and methods: We present the case of a puerperal young woman with progressive headache, seizures and decreased alertness. Thrombosis of the entire superior sagittal sinus with bifrontal venous infarcts and midline shift was confirmed by magnetic resonance imaging with venography sequencing. Despite medical treatment with anticoagulation, progressive neurological deterioration was observed, so bilateral, frontal decompressive craniectomy was performed.
Results: At the 6-month follow-up, we observed partial functional recovery with a modified Rankin score of 3.
Discussion: Bilateral decompressive craniectomy may be a life-saving therapeutic option when medical therapy fails and there are clinical and radiological features of progression in both cerebral hemispheres.