Neurology India Medknow Publications on behalf of the Neurological Society of India ISSN: 0028-3886 EISSN: 1998-4022 Vol. 58, Num. 6, 2010, pp. 980-981

Neurology India, Vol. 58, No. 6, November-December, 2010, pp. 980-981

Correspondence

Decompressive surgery for severe cerebral venous sinus thrombosis

Satoru Takeuchi¹, Yoshio Takasato²

¹ Department of Neurosurgery, National Defense Medical College, Saitama 359-8513, Japan
² National Hospital Organization Disaster Medical Center, Tokyo, Japan

Correspondence Address:
Satoru Takeuchi
Department of Neurosurgery, National Defense Medical College, Saitama 359-8513
Japan
s.takeuchi@room.ocn.ne.jp

Date of Acceptance: 23-Nov-2010

Code Number: ni10285

PMID: 21150086

DOI: 10.4103/0028-3886.73761

Sir,

Lath et al. ^[1] reported case series of malignant cerebral venous and sinus thrombosis (CVST) treated with decompressive craniectomy. In their study, decompressive craniectomy was reported to be beneficial as a life-saving procedure for malignant CVST. Several authors also reported the same result. ^[2],[3] We would like to add a comment regarding this point. We previously reported a case of refractory CVST associated with thrombocythemia. ^[4] Despite treatment with intravenous heparin, oral warfarin, and local thrombolysis, the patient's high intracranial pressure (ICP) continued. At that time, we considered that decompressive hemicraniectomy might be useful to decrease ICP. However, cerebral angiography revealed prominent collateral venous systems draining into the dura, skull, and scalp. As we considered that hemicraniectomy might cause aggravation of the patient due to injury to important draining systems to the dura, skull, or scalp, the patient was instead treated with barbiturate coma therapy and continuous spinal drainage. Developing collateral venous systems and draining to the skull or the scalp may be observed in cases of CVST. ^[5] Decompressive hemicraniectomy should be performed in an area free from collateral draining veins because compromising these veins can result in serious sequelae. If possible, we suggest that patients of refractory CVST should be evaluated for collateral venous systems draining to the dura, skull, or scalp prior to hemicraniectomy. Of course, we cannot do so in cases with life-threatening state because we also consider that surgical delay after deterioration is a key factor affecting therapeutic efficacy.

References

1.	Lath R, Kumar S, Reddy R, Boola GR, Ray A, Prabhakar S, et al. Decompressive surgery for severe cerebral venous sinus thrombosis. Neurol India 2010;58:392-7.  Back to cited text no. 1  [PUBMED]
2.	Dohmen C, Galldiks N, Moeller-Hartmann W, Fink GR, Timmermann L. Sequential escalation of therapy in "malignant" cerebral venous and sinus thrombosis. Neurocrit Care 2010;12:98-102.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]
3.	Coutinho JM, Majoie CB, Coert BA, Stam J. Decompressive hemicraniectomy in cerebral sinus thrombosis: Consecutive case series and review of the literature. Stroke 2009;40:2233-5.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.	Takeuchi S, Takasato Y, Masaoka H, Hayakawa T, Otani N, Yoshino Y, et al. A case of cerebral venous thrombosis associated with thrombocythemia. No Shinkei Geka 2009;37:697-702.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]
5.	Leach JL, Fortuna RB, Jones BV, Gaskill-Shipley MF. Imaging of cerebral venous thrombosis: Current techniques, spectrum of findings, and diagnostic pitfalls. Radiographics 2006;26:S19-41.  Back to cited text no. 5  [PUBMED]  [FULLTEXT]

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