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Bilateral Decompressive Craniectomy in Malignant Cerebral Venous Thrombosis

2020; SMC MEDIA SRL; Issue: LATEST ONLINE Linguagem: Inglês

10.12890/2020_001560

2284-2594

Eduardo Soriano-Navarro, Vanessa Cano-Nigenda, Fernanda Menéndez-Manjarrez, Esmirna Farington-Terrero, Juan José Méndez-Gallardo, Alejandro García-Irigoyen, Antonio Araúz,

Venous Thromboembolism Diagnosis and Management

Despite the extremely favourable prognosis of patients with cerebral venous thrombosis (CVT), death occurs in 10-15% of patients. In severe cases of malignant CVT with supratentorial haemorrhagic lesions, cerebral oedema and brain herniation, decompressive surgery may be the only life-saving treatment.We present the case of a puerperal young woman with progressive headache, seizures and decreased alertness. Thrombosis of the entire superior sagittal sinus with bifrontal venous infarcts and midline shift was confirmed by magnetic resonance imaging with venography sequencing. Despite medical treatment with anticoagulation, progressive neurological deterioration was observed, so bilateral, frontal decompressive craniectomy was performed.At the 6-month follow-up, we observed partial functional recovery with a modified Rankin score of 3.Bilateral decompressive craniectomy may be a life-saving therapeutic option when medical therapy fails and there are clinical and radiological features of progression in both cerebral hemispheres.Malignant cerebral venous thrombosis presents with diffuse haemorrhagic lesions or cerebral oedema associated with brain herniation and rapid clinical deterioration.Decompressive surgery may be the only life-saving treatment in severe cases.Early and adequate intervention based on the characteristics of the lesions allowed preservation of life and improvement in long-term functionality.