去骨瓣减压术
医学
外科
血栓形成
改良兰金量表
静脉血栓形成
冲程(发动机)
中线偏移
开颅术
下腔静脉
静脉造影
麻醉
创伤性脑损伤
计算机断层摄影术
缺血性中风
内科学
缺血
工程类
精神科
机械工程
作者
Sanjith Aaron,Mathew Alexander,Ranjith K Moorthy,Sunithi Mani,Vivek Mathew,Anil Kumar Patil,Ajith Sivadasan,Shalini Nair,Mathew Joseph,Maya Thomas,Krishna Prabhu,Baylis Vivek Joseph,Vedantam Rajshekhar,Ari G Chacko
标识
DOI:10.1136/jnnp-2012-303356
摘要
Background
Cerebral venous thrombosis (CVT) is an important cause for stroke in the young where the role for decompressive craniectomy is not well established. Objective
To analyse the outcome of CVT patients treated with decompressive craniectomy. Methods
Clinical and imaging features, preoperative findings and long-term outcome of patients with CVT who underwent decompressive craniectomy were analysed. Results
Over 10 years (2002–2011), 44/587 (7.4%) patients with CVT underwent decompressive craniectomy. Diagnosis of CVT was based on magnetic resonance venography (MRV)/inferior vena cava (IVC). Decision for surgery was taken at admission in 19/44 (43%), within 12 h in 5/44 (11%), within first 48 h in 15/44 (34%) and beyond 48 h in 10/44 (22%). Presence of midline shift of ≥10 mm (p<0.0009) and large infarct volume (mean 146.63 ml; SD 52.459, p<0.001) on the baseline scan influenced the decision for immediate surgery. Hemicraniectomy was done in 38/44 (86%) and bifrontal craniectomy in 6/44 (13.6%). Mortality was 9/44 (20%). On multivariate analysis (5% level of significance) age <40 years and surgery within 12 h significantly increased survival. Mean follow-up was 25.5 months (range 3–66 months), 26/35 (74%) had 1 year follow-up. Modified Rankin Scale (mRs) continued to improve even after 6 months with 27/35 (77%) of survivors achieving mRs of ≤2. Conclusions
This is the largest series on decompressive craniectomy for CVT in literature to date. Decompressive craniotomy should be considered as a treatment option in large venous infarcts. Very good outcomes can be expected especially if done early and in those below 40 years.
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