Neurosurgeons are often involved in the care of patients with cerebral venous sinus thrombosis (CVST). Medical management of CVST includes appropriate diagnostic imaging studies, evaluation for potentially treatable causes of thrombosis, and control of increased intracranial pressure with medications and cerebrospinal fluid drainage. Seizure prophylaxis is indicated in the acute phase of disease and should be continued indefinitely in selected patients. Systemic anticoagulation with heparin and warfarin is the mainstay of medical treatment of CVST; anticoagulation is safe and effective even in the presence of intracerebral hemorrhage. Patients who deteriorate neurologically despite appropriate medical treatment are candidates for endovascular treatment. Endovascular interventions include infusion of thrombolytic agents directly into the thrombosed sinus and mechanical thrombectomy with balloons or rheolytic catheters. These interventions are effective and generally safe, although local thrombolytic infusions increase the risk of new or worsened intracranial hemorrhages. Chronic CVST with stenosis of the venous sinuses may be treated with balloon angioplasty and stenting. Under rare circumstances, open surgical interventions may be considered, including open thrombectomy and decompressive craniectomy. Neurosurgeons should also be prepared to treat late complications of CVST, including pseudotumor cerebri and dural arteriovenous fistulas. In summary, CVST is a serious but treatable disease, and effective medical, endovascular, and open surgical therapies exist.
- Cerebral venous sinus thrombosis
- Endovascular surgery
ASJC Scopus subject areas
- Clinical Neurology