• World Neurosurg · Dec 2018

    Review Case Reports

    Surgical thrombectomy combined with bilateral decompressive craniectomy in a desperate case of coma from cerebral venous sinus thrombosis: case report and literature review.

    • François Lechanoine, Kévin Janot, Denis Herbreteau, Igor Lima Maldonado, and Stéphane Velut.
    • Neurosurgery Department, Centre Hospitalier Régional Universitaire de Tours, Tours, France; UMR 1253, iBrain, Université de Tours, Inserm, Tours, France. Electronic address: francois.lechanoine@neurochirurgie.fr.
    • World Neurosurg. 2018 Dec 1; 120: 485-489.

    BackgroundCerebral venous sinus thrombosis (CVST) is a rare cause of stroke. Medical and neurointerventional strategies, such as in situ thrombolysis, are standard therapies. These techniques are insufficient when clinical deterioration arises from mass-associated effects and transtentorial herniation; in such cases, decompressive hemicraniectomy may be indicated. To the best of our knowledge, the association of open surgical thrombectomy with bilateral decompressive craniectomy has not been reported to date.Case DescriptionA 45-year-old woman presented with extensive cerebral venous sinus thrombosis that was resistant to anticoagulation and endovascular therapies. Her clinical condition deteriorated until she became comatose, and bilateral hemicraniectomy combined with open surgical thrombectomy through the superior sagittal sinus was indicated. Computed tomography angiography confirmed postoperative maintenance of sinus permeability. The patient's clinical status improved dramatically, and she had a favorable outcome, including recovery of her functional independence to perform all activities of daily living (modified Rankin Scale score = 0). The follow-up period was 5 years.ConclusionsOpen surgical thrombectomy combined with decompressive craniectomy is a lifesaving procedure that can lead to favorable outcome and should be considered for treatment of refractory malignant cerebral venous sinus thrombosis.Copyright © 2018 Elsevier Inc. All rights reserved.

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