Group Name

the DECOMPRESS2 study group

Background And Aims

Decompressive neurosurgery is recommended in patients with cerebral venous thrombosis (CVT) and impending brain herniation. We aimed to evaluate predictors of mortality in a large prospective cohort of CVT patients treated with decompressive craniectomy.

Methods

DECOMPRESS2 was a multinational prospective register of consecutive patients with CVT (2011-2020) treated by decompressive neurosurgery in which 118 patients were included (80 women, median age 38 years, 115 craniectomies, 37 hematoma evacuations). Outcomes were evaluated at discharge, 6 and 12 months.Twelve-month follow up data was available for 113 patients (96%). Causes of death were adjudicated and Firth penalized maximum likelihood logistic regression was performed to identify predictors of mortality.

Results

Forty patients (34%) died after decompressive neurosurgery, of whom 25 (21%) during the first 30 days. The median time between diagnosis and surgery was 1 day (IQR 0-2). Median time between CVT diagnosis and death was 14 days, and between surgery and death, 9 days. The most common causes were brain herniation (n=17, 43%) and infection (n=12, 30%). Independent predictors of death were age (OR [10 years] 1.52; 95%CI:1.06-2.18), posterior fossa lesion (OR 9.28; 95%CI:1.33-64.52), bilateral dilated fixed pupils before surgery (OR 6.47; 95%CI:1.47-28.34) and bilateral decompressive surgery (OR 7.51; 95%CI:1.40-40.37).

Conclusions

Most deaths occurred within the first 30 days after surgery. Older age, posterior fossa lesion, bilateral fixed pupils before surgery and bilateral decompressive surgery were independent predictors of death. Improving patient selection and optimizing the timing of surgery may further improve the outcome of these severely affected patients with CVT.

Trial Registration Number

Not applicable

Group Name

DECOMPRESS2 Study Group

Background And Aims

Decompressive neurosurgery is recommended in patients with cerebral venous thrombosis (CVT) with large lesions and impending brain herniation. This recommendation is supported by a low level of evidence (retrospective, small sample size studies). We report the 12 months outcome of CVT patients treated by DN in a large multicenter prospective cohort.

Methods

We included consecutive CVT patients treated by decompressive neurosurgery at participating centres. Outcomes were evaluated at discharge, 6 and 12 months by the modified Rankin Scale (mRS) and by patient/caregiver opinion on the benefit of surgery.

Results

118 patients (80 women, median age 38 years) were included from 15 centers in Europe, Asia, and America. Decompressive neurosurgery (115 craniectomies, 37 hematoma evacuations) was performed on a median of 1 day after diagnosis. Before surgery, 68 (57.6%) patients were comatose. Pupillary reflexes were absent unilaterally in 27 (22.9%) and bilaterally in 9 (7.6%).

Twelve-month follow up data was available for 113 (95.8%) patients. Four (3.4%) patients had only 6 months follow up. Forty (33.9%) patients had died (28 during the acute phase), 42 (35.6%) were independent (mRS 0-2), while only 12 patients (10.2%) were severely dependent (mRS 4-5). Among the survivors, 78.9% of the patients and 87.1% of their caregivers had a positive opinion on decompressive neurosurgery.

Conclusions

Despite a severe clinical condition at baseline, two thirds of CVT patients were alive and more than one third were independent one year after decompressive surgery. Decompressive neurosurgery was judged as worthwhile by 4 out of 5 patients/caregivers.

Trial Registration Number

Not applicable

Group Name

DECOMPRESS2 Study Group

Background And Aims

Decompressive neurosurgery is recommended in patients with cerebral venous thrombosis (CVT) with large lesions and impending brain herniation. This recommendation is supported by a low level of evidence (retrospective, small sample size studies). We report the 12 months outcome of CVT patients treated by DN in a large multicenter prospective cohort.

Methods

We included consecutive CVT patients treated by decompressive neurosurgery at participating centres. Outcomes were evaluated at discharge, 6 and 12 months by the modified Rankin Scale (mRS) and by patient/caregiver opinion on the benefit of surgery.

Results

118 patients (80 women, median age 38 years) were included from 15 centers in Europe, Asia, and America. Decompressive neurosurgery (115 craniectomies, 37 hematoma evacuations) was performed on a median of 1 day after diagnosis. Before surgery, 68 (57.6%) patients were comatose. Pupillary reflexes were absent unilaterally in 27 (22.9%) and bilaterally in 9 (7.6%).

Twelve-month follow up data was available for 113 (95.8%) patients. Four (3.4%) patients had only 6 months follow up. Forty (33.9%) patients had died (28 during the acute phase), 42 (35.6%) were independent (mRS 0-2), while only 12 patients (10.2%) were severely dependent (mRS 4-5). Among the survivors, 78.9% of the patients and 87.1% of their caregivers had a positive opinion on decompressive neurosurgery.

Conclusions

Despite a severe clinical condition at baseline, two thirds of CVT patients were alive and more than one third were independent one year after decompressive surgery. Decompressive neurosurgery was judged as worthwhile by 4 out of 5 patients/caregivers.

Trial Registration Number

Not applicable