Acute Posttraumatic Cerebral Venous Sinus Thrombosis-Induced Malignant Increased Intracranial Pressure Treated with Endovascular Dural Sinus Thrombectomy and Stenting.

BACKGROUND: Posttraumatic cerebral venous sinus thrombosis (CVST) is a major complication after head injury. Impaired venous outflow caused by CVST leads to increased intracranial pressure (IICP) refractory to medications and surgical decompression and often results in devastating consequences. Currently, there is no consensus on the treatment strategy.

CASE DESCRIPTION: Here we report a case of posttraumatic CVST in a young male motorcyclist involved in a high-speed traffic accident. On admission, the patient immediately underwent decompressive hemicraniectomy. However, refractory malignant IICP developed within 24 hours after the operation. Computed tomography venography revealed compression of the right sigmoid sinus by the fractured temporal bone and extensive thrombosis toward the jugular bulb. Dural sinus thrombectomy and stenting were performed accordingly. After the procedure, IICP was alleviated immediately and the sedatives and medications were tapered off within days. The patient gradually recovered from deep comatose status and underwent cranioplasty 5 weeks later. Finally, the patient was discharged with only mild left wrist weakness.

CONCLUSIONS: Acute cerebral sinus thrombosis caused by trauma may result in malignant IICP refractory to medications and surgical decompression. We have demonstrated that endovascular angioplasty and sinus stenting are effective in restoring venous outflow and reducing intracranial pressure. We have also demonstrated that appropriate and timely interventions are important to ensure quick and good recovery in patients with CVST.