J Neurosurg 117:738–744, 2012 738 J Neurosurg / Volume 117 / October 2012 C erebral venous sinus thrombosis is a distinct cere- brovascular disorder that, unlike arterial stroke, most often affects young adults and children. 1 The symptoms and clinical course are highly variable. Its clinical evolution seems to be different from other stroke subtypes and is highly variable between studies. Patients often present with protean neurological manifestations in the form of focal neurological defcits, seizures, head- ache, and other effects of raised intracranial tension, lead- ing to misdiagnosis and delay in treatment. 8 Treatment of sinus thrombosis with heparin and its derivatives is safe, and is likely to improve its outcome. Local endovascu- lar thrombolysis may improve outcome in selected cases, but has only been tried in small, uncontrolled case series. Despite improvements in diagnosis and treatment, du- ral sinus thrombosis may still cause death or permanent disability. Venous stasis, brain infarction, and ICH may cause signifcant mass effect and increased ICP. Some- times, medical interventions to reduce ICP are of minimal beneft, and surgical intervention in the form of decom- The role of decompressive craniectomy in cerebral venous sinus thrombosis Clinical article Thanga ThirupaThi rajan ViVakaran, M.S., M.Ch., 1 DwarakanaTh SriniVaS, M.S., M.Ch., 1 giriSh BaBurao kulkarni, D.M., 2 anD SaMpaTh SoManna, M.Ch. 1 Departments of 1 Neurosurgery and 2 Neurology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India Object. Studies on the role of decompressive craniectomy for cerebral venous sinus thrombosis (CVST) in the literature are scanty. Randomized trials face a lot of drawbacks, including ethical issues. In this article the authors discuss their experience with this procedure for CVST and review the available literature. Methods. This study was a retrospective analysis of all patients who underwent decompressive craniectomy for CVST between August 2006 and June 2008 at the National Institute of Mental Health and Neurosciences. The cases were evaluated for demographic and clinicoradiological features, operative fndings, and outcome of surgery. Ethical clearance was obtained from the institutional ethics committee. The data for each patient were obtained from the da- tabase of the department. Follow-up data were obtained either through direct clinical evaluation or mailed self-report questionnaire. The Glasgow Outcome Scale (GOS) and the Rankin Disability Scale were used to assess the outcome. Results. A total of 34 patients (13 men and 21 women) were included; their mean age was 31.6 years, with a range from 18 to 65 years. In univariate analysis, the Glasgow Coma Scale (GCS) score prior to surgery and that in the immediate postoperative period had a statistically signifcant correlation with poor outcome. The GCS score im- mediately postoperatively was the only independent, signifcant predictor of poor outcome on multivariate analysis. Conclusions. Decompressive craniectomy in a selected cohort of patients had a good outcome in a majority of the patients: 26 of 34 in this study had a GOS score of 4 or 5. In this series, which is the largest in the available litera- ture, the authors review their experience and recommend usage of this procedure in selected patients. (http://thejns.org/doi/abs/10.3171/2012.6.JNS11102) key worDS • cerebral venous sinus thrombosis • vascular disorders • decompressive craniectomy Abbreviations used in this paper: CVST = cerebral venous sinus thrombosis; GCS = Glasgow Coma Scale; GOS = Glasgow Out- come Scale; ICH = intracerebral hemorrhage; ICP = intracranial pressure; ISCVT = International Study on Cerebral Vein and Dural Sinus Thrombosis; RDS = Rankin Disability Scale. See the corresponding editorial in this issue, pp 735–737.