Seizures after decompressive surgery for cerebral venous thrombosis

Introduction: The incidence and outcomes of seizures among patients with severe cerebral venous thrombosis treated with decompressive surgery are unknown as are potential predictors of seizures in these patients. Patients and methods: We report data from a multicenter, consecutive cohort including patients with cerebral venous thrombosis treated with decompressive surgery from 15 hospitals in 10 different countries between December 2011 and December 2019. We analyzed the cumulative incidence of seizures within one year after decompressive surgery and performed an exploratory analysis of potential factors associated with the incidence of post-surgery seizures, adjusted for competing mortality risk. Results: Of 116 included patients (median age 38 years [IQR 27–46], 68% female), 26 (22%) had seizures within one year after decompressive surgery. The mortality-adjusted cumulative one-year incidence of a first seizure after surgery was 23% (95% CI 16–31). Only aphasia at presentation predicted post-surgery seizures. Among patients who had a post-surgery seizure, the first seizure occurred despite active treatment with anti-seizure medications in 83% of patients. Recurrent seizures within the first year after surgery were reported in 63% of patients. Discussion and conclusion: Despite extensive use of anti-seizure medications, in patients with cerebral venous thrombosis treated with decompressive surgery the rate of seizures was 23% (95% CI 16–31) within one year after surgery. Of the patients who had a seizure after surgery, 63% had a recurrent seizure within the first year post-surgery.