A 54-year-old man with no medical history presented to our hospital with
vomiting, left
hemiplegia, and
seizures. On arrival, he was experiencing
generalized tonic-clonic seizures, which required him to be intubated and deeply sedated. Contrast-enhanced computed tomography revealed extensive venous sinus obstruction from the superior sagittal sinus to the bilateral sigmoid sinus and
cerebral edema with
intracranial hemorrhage. An intracranial pressure (ICP) monitor was immediately placed intracranially, and mechanical
thrombectomy (MT) was performed under ICP monitoring. MT was immediately terminated when the venous sinus was partially recanalized enough to decrease the ICP; then, anticoagulation
therapy was initiated. Postoperative follow-up angiography revealed that venous sinus obstruction and intracranial venous perfusion improved over time. Although he had
intracranial hemorrhage-induced left
hemiplegia and sensory deficits, his condition improved with rehabilitation, and the patient was eventually discharged home. The indication criteria and techniques for MT for cerebral venous
sinus thrombosis are yet to be established. As in this case, in patients with impaired consciousness due to
intracranial hemorrhage or
epilepsy, preoperative ICP monitor placement is deemed useful to evaluate venous perfusion during MT and decide the treatment goal.