DECOMPRESS2 Study Group
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.
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.
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.
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.
Not applicable