Decompressive hemicraniectomy for patients with malignant cerebral venous sinus thrombosis

Background and objective: Cerebral venous sinus thrombosis (CVST) is a rare cause of stroke and may lead to the development of raised intracranial pressure due to edema, infarct or bleed. These patients may require decompressive hemicraniectomy to reduce the raised intracranial pressure. However, the evidence for hemicraniectomy in these patients is scanty. Our objective was to perform a retrospective chart review to describe the clinical characteristics of patients who underwent decompressive hemicraniectomy for malignant CVT and their outcomes. Methods: We retrospectively analyzed the medical records of patients with CVST who underwent decompressive hemicraniectomy between 2013 and 2020 at Shifa International Hospital. All patients with CVST diagnosed on the basis of clinical and radiographic findings were included in the study. Patients with primary or metastatic brain tumors were excluded from the study. Results: A total of 138 patients with CVST presented to our hospital. Twenty-seven (19.6) developed malignant CVST. Of these patients, 10 underwent decompressive hemicraniectomy (7.2% of total). None of the patients died and seven patients (70%) had a modified Rankin scale score of 2 or less at three months. Conclusion: Decompressive hemicraniectomy should be considered for patients presenting with malignant CVST who do not respond to medical treatment.