Neurosurgical Considerations Regarding Decompressive Craniectomy for Intracerebral Hemorrhage after SARS-CoV-2-Vaccination in Vaccine Induced Thrombotic Thrombocytopenia-VITT

Florian Gessler; Ann Kristin Schmitz; Daniel Dubinski; Joshua D Bernstock; Felix Lehmann; Sae-Yeon Won; Matthias Wittstock; Erdem Güresir; Alexis Hadjiathanasiou; Julian Zimmermann; Wolfgang Miesbach; Thomas Freiman; Hartmut Vatter; Patrick Schuss

doi:10.3390/jcm10132777

Neurosurgical Considerations Regarding Decompressive Craniectomy for Intracerebral Hemorrhage after SARS-CoV-2-Vaccination in Vaccine Induced Thrombotic Thrombocytopenia-VITT

J Clin Med. 2021 Jun 24;10(13):2777. doi: 10.3390/jcm10132777.

Affiliations

¹ Department of Neurosurgery, University Medicine Rostock, 18055 Rostock, Germany.
² Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany.
³ Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
⁴ Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, 53127 Bonn, Germany.
⁵ Department of Neurology, University Medicine Rostock, 18055 Rostock, Germany.
⁶ Department of Neurology, University Hospital Bonn, 53127 Bonn, Germany.
⁷ Department of Coagulation Disorders, University Hospital Frankfurt, 60590 Frankfurt, Germany.

Abstract

Given the ongoing global SARS-CoV-2-vaccination efforts, clinical awareness needs to be raised regarding the possibility of an increased incidence of SARS-CoV-2-vaccine-related immune-mediated thrombocytopenia in patients with intracerebral hemorrhage (ICH) secondary to cerebral sinus and vein thrombosis (CVT) requiring (emergency) neurosurgical treatment in the context of vaccine-induced immune thrombotic thrombocytopenia (VITT). Only recently, an association of vaccinations and cerebral sinus and vein thrombosis has been described. In a number of cases, neurosurgical treatment is warranted for these patients and special considerations are warranted when addressing the perioperative coagulation. We, herein, describe the past management of patients with VITT and established a literature-guided algorithm for the treatment of patients when addressing the impaired coagulation in these patients. Increasing insights addressing the pathophysiology of SARS-CoV-2-vaccine-related immune-mediated thrombocytopenia guide physicians in developing an interdisciplinary algorithm taking into account the special considerations of this disease.

Keywords: Covid-19; SARS-CoV-2; cerebral sinus and vein thrombosis (CVT); decompressive craniectomy; intracerebral hemorrhage (ICH); vaccination; vaccine-induced immune thrombotic thrombocytopenia (VITT).