Thrombose du sinus veineux cérébral: Thrombectomie chirurgicale & Craniectomie bilatérale décompressive

Surgical thrombectomy combined with bilateral decompressive craniectomy in a desperate case of coma from cerebral venous sinus thrombosis: case report and literature review.

Abstract

Background - Cerebral venous sinus thrombosis (CVST) is a rare cause of stroke. Medical and neurointerventional strategies such as in situ thrombolysis are among the standard therapies. However, these techniques are insufficient when clinical deterioration arises from mass-associated effects and transtentorial herniation, whereupon decompressive hemicraniectomy may be indicated. To the best of our knowledge, the association of open surgical thrombectomy with bilateral decompressive craniectomy has not been reported to date.

Case description - We describe a case of a 45-year-old woman presenting with extensive CVST, which was resistant to anticoagulation and endovascular therapies. Clinical aggravation until coma led to the indication of bilateral hemicraniectomy combined with open surgical thrombectomy through the superior sagittal sinus. Computed tomography (CT) angiograms confirmed postoperative maintenance of sinus permeability. The clinical status improved dramatically and the patient presented with a favorable outcome, recovering her functional independence to all activities of daily living (modified Rankin Status (mRS) = 0). The follow-up period was five years.

Conclusions - Open surgical thrombectomy combined with decompressive craniectomy is a life-saving procedure that can lead to favorable outcome and should be considered as part of the neurosurgical arsenal for the treatment of refractory malignant CVST.

Keywords

Case report; decompressive craniectomy; malignant cerebral venous sinus thrombosis; neurosurgery; thrombectomy.