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(Stroke. 2009;40:2233.)
© 2009 American Heart Association, Inc.

Research Letters

Decompressive Hemicraniectomy in Cerebral Sinus Thrombosis

Consecutive Case Series and Review of the Literature

Jonathan M. Coutinho, MD, MSc; Charles B.L.M. Majoie, MD, PhD; Bert A. Coert, MD, PhD Jan Stam, MD, PhD

From the Departments of Neurology (J.M.C., J.S.), Radiology (C.B.L.M.M.), and Neurosurgery (B.A.C.) Academic Medical Centre, University of Amsterdam, The Netherlands.

Correspondence to Prof Dr J. Stam, Department of Neurology (room H2-226), Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. E-mail j.stam{at}amc.uva.nl

Background and Purpose— Thirteen percent of patients with cerebral venous and sinus thrombosis (CVST) has a poor clinical outcome. In patients with a poor prognosis, endovascular thrombolysis can be considered, but this procedure does not appear to be beneficial in patients with impending transtentorial herniation because of large hemorrhagic venous infarcts. Therefore, halfway through 2006, we changed our policy to decompressive hemicraniectomy in these patients.

Methods and Results— Patients with CVST and impending herniation attributable to venous infarcts were eligible for surgical intervention. Since 2006 we consecutively treated 3 patients with decompressive hemicraniectomy. Two patients had an excellent outcome. The third patient, who had been comatose for at least 12 hours before surgery, died despite intervention.

Conclusions— Our data suggest that decompressive hemicraniectomy can be life-saving and can result in an excellent outcome in patients with severe CVST.

Key Words: sinus thrombosis • intracranial • craniotomy • cerebrovascular disorders