Outcomes After Decompressive Surgery for Severe Cerebral Venous Sinus Thrombosis Associated or Not Associated with Vaccine-Induced Immune Thrombosis with Thrombocytopenia: A Multicenter Cohort Study

Johann Otto Pelz¹, Martin Kenda², Angelika Alonso³, Nima Etminan⁴, Matthias Wittstock⁵, Wolf-Dirk Niesen⁶, Johann Lambeck⁶, Erdem Güresir^{7

8}, Johannes Wach^{7

8}, Tim Lampmann⁷, Rainer Dziewas⁹, Markus Wiedmann¹⁰, Hauke Schneider^{11

12}, Antonios Bayas¹¹, Monika Christ¹¹, Annerose Mengel¹³, Sven Poli¹³, Dirk Brämer¹⁴, Dirk Lindner⁸, Christian Pfrepper¹⁵, Christian Roth¹⁶, Farid Salih^#², Albrecht Günther^#¹⁴, Dominik Michalski^#¹⁷; IGNITE Study Group

Affiliations

¹ Department of Neurology, University Hospital Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany. johann.pelz@medizin.uni-leipzig.de.
² Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Campus, Virchow-Klinikum, Berlin, Germany.
³ Department of Neurology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
⁴ Department of Neurosurgery, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
⁵ Department of Neurology, University Medicine Rostock, Rostock, Germany.
⁶ Department of Neurology and Clinical Neurophysiology, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany.
⁷ Department of Neurosurgery, University Hospital Bonn, Bonn, Germany.
⁸ Department of Neurosurgery, University Hospital Leipzig, Leipzig, Germany.
⁹ Department of Neurology and Neurorehabilitation, Klinikum Osnabrueck, Osnabrueck, Germany.
¹⁰ Department of Neurosurgery, Oslo University Hospital, Oslo, Norway.
¹¹ Department of Neurology, University Hospital Augsburg, Augsburg, Germany.
¹² Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
¹³ Department of Neurology and Stroke, University Hospital Tuebingen, Eberhard-Karls University, Tuebingen, Germany.
¹⁴ Department of Neurology, Jena University Hospital, Jena, Germany.
¹⁵ Division of Haemostaseology, Medical Department I, University Hospital Leipzig, Leipzig, Germany.
¹⁶ Department of Neurology, Klinikum Kassel, Kassel, Germany.
¹⁷ Department of Neurology, University Hospital Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany.

^# Contributed equally.

PMID: 37498459
PMCID: PMC10959787
DOI: 10.1007/s12028-023-01782-6

Multicenter Study

Outcomes After Decompressive Surgery for Severe Cerebral Venous Sinus Thrombosis Associated or Not Associated with Vaccine-Induced Immune Thrombosis with Thrombocytopenia: A Multicenter Cohort Study

Johann Otto Pelz et al. Neurocrit Care. 2024 Apr.

. 2024 Apr;40(2):621-632.

doi: 10.1007/s12028-023-01782-6. Epub 2023 Jul 27.

Authors

Affiliations

¹ Department of Neurology, University Hospital Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany. johann.pelz@medizin.uni-leipzig.de.
² Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Campus, Virchow-Klinikum, Berlin, Germany.
³ Department of Neurology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
⁴ Department of Neurosurgery, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
⁵ Department of Neurology, University Medicine Rostock, Rostock, Germany.
⁶ Department of Neurology and Clinical Neurophysiology, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany.
⁷ Department of Neurosurgery, University Hospital Bonn, Bonn, Germany.
⁸ Department of Neurosurgery, University Hospital Leipzig, Leipzig, Germany.
⁹ Department of Neurology and Neurorehabilitation, Klinikum Osnabrueck, Osnabrueck, Germany.
¹⁰ Department of Neurosurgery, Oslo University Hospital, Oslo, Norway.
¹¹ Department of Neurology, University Hospital Augsburg, Augsburg, Germany.
¹² Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
¹³ Department of Neurology and Stroke, University Hospital Tuebingen, Eberhard-Karls University, Tuebingen, Germany.
¹⁴ Department of Neurology, Jena University Hospital, Jena, Germany.
¹⁵ Division of Haemostaseology, Medical Department I, University Hospital Leipzig, Leipzig, Germany.
¹⁶ Department of Neurology, Klinikum Kassel, Kassel, Germany.
¹⁷ Department of Neurology, University Hospital Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany.

^# Contributed equally.

PMID: 37498459
PMCID: PMC10959787
DOI: 10.1007/s12028-023-01782-6

Erratum in

Correction: Outcomes After Decompressive Surgery for Severe Cerebral Venous Sinus Thrombosis Associated or Not Associated with Vaccine-Induced Immune Thrombosis with Thrombocytopenia: A Multicenter Cohort Study.
Pelz JO, Kenda M, Alonso A, Etminan N, Wittstock M, Niesen WD, Lambeck J, Güresir E, Wach J, Lampmann T, Dziewas R, Wiedmann M, Schneider H, Bayas A, Christ M, Mengel A, Poli S, Brämer D, Lindner D, Pfrepper C, Roth C, Salih F, Günther A, Michalski D; IGNITE Study Group. Pelz JO, et al. Neurocrit Care. 2025 Oct;43(2):711-712. doi: 10.1007/s12028-025-02354-6. Neurocrit Care. 2025. PMID: 40825920 Free PMC article. No abstract available.

Abstract

Background: Clinical observations indicated that vaccine-induced immune thrombosis with thrombocytopenia (VITT)-associated cerebral venous sinus thrombosis (CVST) often has a space-occupying effect and thus necessitates decompressive surgery (DS). While comparing with non-VITT CVST, this study explored whether VITT-associated CVST exhibits a more fulminant clinical course, different perioperative and intensive care unit management, and worse long-term outcome.

Methods: This multicenter, retrospective cohort study collected patient data from 12 tertiary centers to address priorly formulated hypotheses concerning the clinical course, the perioperative management with related complications, extracerebral complications, and the functional outcome (modified Rankin Scale) in patients with VITT-associated and non-VITT CVST, both with DS.

Results: Both groups, each with 16 patients, were balanced regarding demographics, kind of clinical symptoms, and radiological findings at hospital admission. Severity of neurological symptoms, assessed with the National Institute of Health Stroke Scale, was similar between groups at admission and before surgery, whereas more patients with VITT-associated CVST showed a relevant midline shift (≥ 4 mm) before surgery (100% vs. 68.8%, p = 0.043). Patients with VITT-associated CVST tended to undergo DS early, i.e., ≤ 24 h after hospital admission (p = 0.077). Patients with VITT-associated CVST more frequently received platelet transfusion, tranexamic acid, and fibrinogen perioperatively. The postoperative management was comparable, and complications were evenly distributed. More patients with VITT-associated CVST achieved a favorable outcome (modified Rankin Scale ≤ 3) at 3 months (p = 0.043).

Conclusions: Although the prediction of individual courses remains challenging, DS should be considered early in VITT-associated CVST because an overall favorable outcome appears achievable in these patients.

Keywords: COVID-19; Cerebral venous sinus thrombosis; Decompressive surgery; Space-occupying infarction; VITT; Vaccination; Vaccine-induced immune thrombosis with thrombocytopenia.

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Conflict of interest statement

FS reports personal fees from Bristol-Myers Squibb as well as MD Horizonte and AMEOS, both outside the submitted work. MW received speakers onoria and consulting fees from Alexion Pharma GmbH (formerly Portola). AG reports personal fees from Bristol-Myers Squibb, Boehringer-Ingelheim, Pfizer, Daichii Sankyo, Ipsen Pharma and Merz. JOP, MK, AA, NE, WDN, JL, EG, JW, TL, RD, MW, HS, AB, MC, AM, SP, DB, DL, CP, CR, and DM declare that there is no conflict of interest related to the presented work.

References

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Outcomes After Decompressive Surgery for Severe Cerebral Venous Sinus Thrombosis Associated or Not Associated with Vaccine-Induced Immune Thrombosis with Thrombocytopenia: A Multicenter Cohort Study

Affiliations

Outcomes After Decompressive Surgery for Severe Cerebral Venous Sinus Thrombosis Associated or Not Associated with Vaccine-Induced Immune Thrombosis with Thrombocytopenia: A Multicenter Cohort Study

Authors

Affiliations

Erratum in

Abstract

Conflict of interest statement

References

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Full Text Sources

Medical