Should decompressive surgery be performed in malignant cerebral venous thrombosis?: a series of 12 patients.

Détails

ID Serval
serval:BIB_1C96E1ACE686
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Should decompressive surgery be performed in malignant cerebral venous thrombosis?: a series of 12 patients.
Périodique
Stroke
Auteur(s)
Théaudin M., Crassard I., Bresson D., Saliou G., Favrole P., Vahedi K., Denier C., Bousser M.G.
ISSN
1524-4628 (Electronic)
ISSN-L
0039-2499
Statut éditorial
Publié
Date de publication
04/2010
Peer-reviewed
Oui
Volume
41
Numéro
4
Pages
727-731
Langue
anglais
Notes
Theaudin, Marie
Crassard, Isabelle
Bresson, Damien
Saliou, Guillaume
Favrole, Pascal
Vahedi, Katayoun
Denier, Christian
Bousser, Marie-Germaine
eng
2010/02/27 06:00
Stroke. 2010 Apr;41(4):727-31. doi: 10.1161/STROKEAHA.109.572909. Epub 2010 Feb 25.
Publication types: Journal Article
Publication Status: ppublish

Résumé
In malignant cerebral venous thrombosis (CVT) patients, emergency decompressive surgery has been suggested as a life-saving procedure. We report 12 patients with malignant CVT, among whom 8 underwent operation.
Retrospective study of 12 patients from 3 stroke units who had a malignant CVT as defined: (1) supratentorial cortical lesions attributable to superficial venous system thrombosis with or without sinus involvement; (2) with clinical (decreased consciousness and dilated pupils) or radiological signs of transtentorial herniation; (3) either at onset or after worsening despite heparin therapy. Surgery or abstention was decided individually by neurosurgeons on call.
There were 9 women and 3 men with a mean age of 45+/-15 years. The delay between heparin therapy and signs of malignancy ranged from 2 to 30 hours. At malignant worsening all but 1 patient had hemorrhagic lesions; the median deviation of septum pellucidum was 12 mm (interquartile range, 6.7-13); 5 patients (including 3 who underwent operation) had a unilateral dilated pupil; and 4 (2 who underwent operation) had bilateral dilated pupils. Eight patients underwent surgical decompression, external decompression in 4, both external and internal decompression in 3, and internal decompression in 1. The 4 patients who did not undergo operation died within 1 to 5 days after diagnosis. One patient who underwent operation died of a pulmonary embolism. The 7 others survived, with, at last follow-up (median, 23.1 months; interquartile range, 19.7-45.6), an excellent recovery of mRS 0 or 1 in 6 and mRS 3 in 1.
Decompressive surgery may save lives and may even allow a good functional outcome in malignant CVT, even in patients with bilateral dilated pupils.

Mots-clé
Adolescent, Adult, Aged, Decompression, Surgical/methods, Female, Humans, Intracranial Thrombosis/mortality, Intracranial Thrombosis/pathology, Intracranial Thrombosis/surgery, Male, Middle Aged, Retrospective Studies, Treatment Outcome, Venous Thrombosis/mortality, Venous Thrombosis/pathology, Venous Thrombosis/surgery, Young Adult
Pubmed
Création de la notice
20/01/2017 16:30
Dernière modification de la notice
03/03/2018 14:32
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