Cranioplasty after Decompressive Craniectomy (DC) in a Patient with Intracerebral Hemorrhage after SARS-CoV-2 Vaccination-Related Vaccine-Induced Thrombotic Thrombocytopenia (VITT)-Proposal of a Management Protocol for This Rare Pathological Condition.
Lennard SpanehlUwe WalterThomas ThieleDaniel DubinskiBedjan BehmaneshThomas M FreimanMatthias WittstockPatrick SchussHartmut VatterMatthias SchneiderFlorian A GesslerSae-Yeon WonPublished in: Journal of clinical medicine (2024)
The COVID-19 (coronavirus disease) pandemic had a severe impact on public health worldwide. A rare but serious complication after administration of adenoviral vaccines against SARS-CoV-2 (AstraZeneca-Oxford and Johnson & Johnson) is vaccine-induced immune thrombotic thrombocytopenia and thrombosis (VITT), which can lead to serious complications such as cerebral venous sinus thrombosis (CVST). CVST itself can cause subarachnoid hemorrhage (SAH) and/or intracerebral hemorrhage (ICH), leading to high mortality due to herniation of brain parenchyma. In those patients, an emergent decompressive hemicraniectomy (DC) is regularly performed. Herein, the authors want to focus on the patients who survive DC following VITT-associated CVST and shed light on the neurosurgical considerations in those patients. We herein propose a treatment algorithm regarding the timing and the perioperative management of cranioplasty. We describe an exemplary case highlighting that special circumstances may result in a more urgent need for autologous cranioplasty than usual, based on individual risk assessment.
Keyphrases
- sars cov
- coronavirus disease
- subarachnoid hemorrhage
- end stage renal disease
- brain injury
- public health
- risk assessment
- chronic kidney disease
- respiratory syndrome coronavirus
- ejection fraction
- peritoneal dialysis
- dendritic cells
- cerebral ischemia
- traumatic brain injury
- prognostic factors
- machine learning
- high glucose
- randomized controlled trial
- coronary artery disease
- cardiovascular disease
- bone marrow
- diabetic rats
- cardiovascular events
- early onset
- severe traumatic brain injury
- mesenchymal stem cells
- middle cerebral artery
- climate change
- endothelial cells
- deep learning
- cardiac surgery
- acute kidney injury