Outcomes of Decompressive Surgery for Patients With Severe Cerebral Venous Thrombosis: DECOMPRESS2 Observational Study

• Type: Article in International Scientific Journal
• Date: 2024

Authors

Aaron, S (Author) Other; Ferreira, JM (Author) Other; Coutinho, JM (Author) Other; Canhao, P (Author) Other; Conforto, AB (Author) Other; Arauz, A (Author) Other; Marta Carvalho (Author) FMUP; Masjuan, J (Author) Other; Sharma, VK (Author) Other; Putaala, J (Author) Other; Uyttenboogaart, M (Author) Other; Werring, DJ (Author) Other; Bazan, R (Author) Other; Mohindra, S (Author) Other; Weber, J (Author) Other; Coert, BA (Author) Other; Kirubakaran, P (Author) Other; van Kammen, MS (Author) Other; Singh, P (Author) Other; de Sousa, DA (Author) Other; Ferro, JM (Author) Other

Journal

Title: Stroke

Vol. 55

Pages: 1218-1226

ISSN: 0039-2499

Publisher: Wolters Kluwer Health

Indexing

ISI Web of Knowledge - 0 Citations

Scopus - 0 Citations

Other information

Authenticus ID: P-010-ANE

DOI: 10.1161/strokeaha.123.045051

Abstract (EN): BACKGROUND:Decompressive neurosurgery is recommended for patients with cerebral venous thrombosis (CVT) who have large parenchymal lesions and impending brain herniation. This recommendation is based on limited evidence. We report long-term outcomes of patients with CVT treated by decompressive neurosurgery in an international cohort.METHODS:DECOMPRESS2 (Decompressive Surgery for Patients With Cerebral Venous Thrombosis, Part 2) was a prospective, international cohort study. Consecutive patients with CVT treated by decompressive neurosurgery were evaluated at admission, discharge, 6 months, and 12 months. The primary outcome was death or severe disability (modified Rankin Scale scores, 5-6) at 12 months. The secondary outcomes included patient and caregiver opinions on the benefits of surgery. The association between baseline variables before surgery and the primary outcome was assessed by multivariable logistic regression.RESULTS:A total of 118 patients (80 women; median age, 38 years) were included from 15 centers in 10 countries from December 2011 to December 2019. Surgery (115 craniectomies and 37 hematoma evacuations) was performed within a median of 1 day after diagnosis. At last assessment before surgery, 68 (57.6%) patients were comatose, fixed dilated pupils were found unilaterally in 27 (22.9%) and bilaterally in 9 (7.6%). Twelve-month follow-up data were available for 113 (95.8%) patients. Forty-six (39%) patients were dead or severely disabled (modified Rankin Scale scores, 5-6), of whom 40 (33.9%) patients had died. Forty-two (35.6%) patients were independent (modified Rankin Scale scores, 0-2). Coma (odds ratio, 2.39 [95% CI, 1.03-5.56]) and fixed dilated pupil (odds ratio, 2.22 [95% CI, 0.90-4.92]) were predictors of death or severe disability. Of the survivors, 56 (78.9%) patients and 61 (87.1%) caregivers expressed a positive opinion on surgery.CONCLUSIONS:Two-thirds of patients with severe CVT were alive and more than one-third were independent 1 year after decompressive surgery. Among survivors, surgery was judged as worthwhile by 4 out of 5 patients and caregivers. These results support the recommendation to perform decompressive neurosurgery in patients with CVT with impending brain herniation.

Language: English

Type (Professor's evaluation): Scientific

No. of pages: 9