{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T17:35:21Z","timestamp":1769103321011,"version":"3.49.0"},"reference-count":23,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2023,3,5]],"date-time":"2023-03-05T00:00:00Z","timestamp":1677974400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Euro J of Neurology"],"published-print":{"date-parts":[[2023,5]]},"abstract":"Abstract<\/jats:title>Background and purpose<\/jats:title>Cerebral venous sinus thrombosis due to vaccine\u2010induced immune thrombotic thrombocytopenia (CVST\u2010VITT) is an adverse drug reaction occurring after severe acute respiratory syndrome coronavirus 2 (SARS\u2010CoV\u20102) vaccination. CVST\u2010VITT patients often present with large intracerebral haemorrhages and a high proportion undergoes decompressive surgery. Clinical characteristics, therapeutic management and outcomes of CVST\u2010VITT patients who underwent decompressive surgery are described and predictors of in\u2010hospital mortality in these patients are explored.<\/jats:p><\/jats:sec>Methods<\/jats:title>Data from an ongoing international registry of patients who developed CVST within 28\u2009days of SARS\u2010CoV\u20102 vaccination, reported between 29 March 2021 and 10 May 2022, were used. Definite, probable and possible VITT cases, as defined by Pavord et al. (N Engl J Med 2021; 385: 1680\u20131689), were included.<\/jats:p><\/jats:sec>Results<\/jats:title>Decompressive surgery was performed in 34\/128 (27%) patients with CVST\u2010VITT. In\u2010hospital mortality was 22\/34 (65%) in the surgical and 27\/94 (29%) in the non\u2010surgical group (p<\/jats:italic>\u2009<\u20090.001). In all surgical cases, the cause of death was brain herniation. The highest mortality rates were found amongst patients with preoperative coma (17\/18, 94% vs. 4\/14, 29% in the non\u2010comatose; p<\/jats:italic>\u2009<\u20090.001) and bilaterally absent pupillary reflexes (7\/7, 100% vs. 6\/9, 67% with unilaterally reactive pupil, and 4\/11, 36% with bilaterally reactive pupils; p<\/jats:italic>\u00a0=\u00a00.023). Postoperative imaging revealed worsening of index haemorrhagic lesion in 19 (70%) patients and new haemorrhagic lesions in 16 (59%) patients. At a median follow\u2010up of 6\u2009months, 8\/10 of surgical CVST\u2010VITT who survived admission were functionally independent.<\/jats:p><\/jats:sec>Conclusions<\/jats:title>Almost two\u2010thirds of surgical CVST\u2010VITT patients died during hospital admission. Preoperative coma and bilateral absence of pupillary responses were associated with higher mortality rates. Survivors often achieved functional independence.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ene.15735","type":"journal-article","created":{"date-parts":[[2023,2,11]],"date-time":"2023-02-11T13:55:35Z","timestamp":1676123735000},"page":"1335-1345","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Decompressive surgery in cerebral venous sinus thrombosis due to vaccine\u2010induced immune thrombotic thrombocytopenia"],"prefix":"10.1111","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9478-0401","authenticated-orcid":false,"given":"Katarzyna","family":"Krzywicka","sequence":"first","affiliation":[{"name":"Department of Neurology Amsterdam University Medical Centers, University of Amsterdam Amsterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6702-7924","authenticated-orcid":false,"given":"Diana","family":"Aguiar\u00a0de\u00a0Sousa","sequence":"additional","affiliation":[{"name":"Stroke Centre Lisbon Central University Hospital Center Lisbon Portugal"},{"name":"CEEM and Institute of Anatomy, Faculty of Medicine University of Lisbon Lisbon Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charlotte","family":"Cordonnier","sequence":"additional","affiliation":[{"name":"INSERM, CHU Lille, U1172 \u2010 LilNCog \u2010 Lille Neuroscience & Cognition University of Lille Lille France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Felix J.","family":"Bode","sequence":"additional","affiliation":[{"name":"Department of Neurology Universit\u00e4tsklinikum Bonn Bonn Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thalia S.","family":"Field","sequence":"additional","affiliation":[{"name":"Vancouver Stroke Program, Division of Neurology University of British Columbia Vancouver British Columbia Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dominik","family":"Michalski","sequence":"additional","affiliation":[{"name":"Department of Neurology Leipzig University Hospital Leipzig Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4391-2280","authenticated-orcid":false,"given":"Johann","family":"Pelz","sequence":"additional","affiliation":[{"name":"Department of Neurology Leipzig University Hospital Leipzig Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mona","family":"Skjelland","sequence":"additional","affiliation":[{"name":"Department of Neurology Oslo University Hospital Oslo Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Markus","family":"Wiedmann","sequence":"additional","affiliation":[{"name":"Department of Surgery Oslo University Hospital Oslo Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julian","family":"Zimmermann","sequence":"additional","affiliation":[{"name":"Department of Neurology Universit\u00e4tsklinikum Bonn Bonn Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthias","family":"Wittstock","sequence":"additional","affiliation":[{"name":"Department of Neurology University Hospital Rostock Rostock Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bruno","family":"Zanotti","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Neurology with Neurosurgical Activity C. 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