1042. Cerebral perfusion changes before and after decompressive craniectomy for Cerebral Venous Sinus Thrombosis (CVST)

Authors: Dwarakanath Srinivas, MBBS, MS, MCh; Varun Reddy, MCh; Aravind Gowda, MD; Sampath Somanna, MCh (Bangalore, India)

Introduction: Cortical Venous Thrombosis (CVT) is a distinct cerebrovascular disorder most often affects young adults.Dynamic Contrast Enhanced MRI (DCE - MRI) with perfusion allows quantification of indices that are directly related to the integrity of the Blood Brain Barrier.The aim of this study is to evaluate changes in local and global cerebral hemodynamics and perfusion before and after decompressive craniectomy Methods: An observational prospective study conducted between 2015 - 2017.All patients underwent DCE- MRI before and after decompressive craniectomy using similar indices. Results: 19 patients underwent surgery were included in the study group, while 17 patients underwent medical management were included in the control group. Perfusion indices like CBV, CBF, K trans , K ep , v e , v p , λ tr (leakage), CBV corrected for leakage, CBV corrected for v e , were analyzed, compared between pre-operative and post-operative with controls. CBV, CBF and their corresponding ratios showed higher values after surgery. The mean follow up period was 10.71 months (Range: 1 – 22 months). The mean GOS at discharge was 3.41 while at follow up it was 4.41. The mean mRS at admission was 4.64, at discharge was 3.41 and at follow up was 1.50. All improved clinically correlating clinically. Conclusion: This is the first study of its kind and opens up new possibilities to prognosticate, management and outcome in CVT . DCE – MRI perfusion serves as non-invasive tool for monitoring treatment response if further studies can document its clinical utility.