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. 2015 Jan-Mar;10(1):17-20.
doi: 10.4103/1793-5482.151503.

Management of superior sagittal sinus injury encountered in traumatic head injury patients: Analysis of 15 cases

Sanjay K Behera  1 , Satya Bhusan Senapati  1 , Sudhansu Sekhar Mishra  1 , Srikant Das  1
Affiliations

Management of superior sagittal sinus injury encountered in traumatic head injury patients: Analysis of 15 cases

Sanjay K Behera et al. Asian J Neurosurg. 2015 Jan-Mar.

Abstract

Background: Significant dural sinus injury occurs in 1.5- 5% of all head injuries and injury to superior sagittal sinus accounts for 70-80% of these. Its management is also a challenging issue to every neurosurgeon.

Materials and methods: In a period of one year (Aug 2011 to july2012) out of 549 cases of head injuries operated in our department analysis of 15 cases (2.73%) shown to have superior sagittal sinus injury. Three dimensional reconstruction of skull bone during CT scan helped us to diagnose possible dural sinus injury pre-operatively.

Results: SSS injury was due to direct impact of fracture segment (5 cases), extension of fracture line over sinus area (4 cases) or due to coronal suture diastases (6 cases). Injury to anterior third of sagittal sinus occurred in 12 cases (80%) and injury to middle third occurred in 3 cases (20%). Small tear over superior sagittal sinus was found in 7 cases (46.66%) and was managed with Gelfoam(®) compression only and in two cases (13.33%) were large tear, which was managed with sinoraphy. In four cases (36.34%) hitch stitches over Gelfoam(®) to adjacent bone given and in rest two cases (13.33%) a strip of bone was left over the sinus area and bilateral hitch stitches were applied.

Conclusion: Injury to SSS in traumatic head injury patient though rarely encountered during surgery, the management is challenging to every neurosurgeon. Preoperative suspicion and combination of surgical techniques rather than one single technique may be effective in decreasing the sinus related mortality rate.

Keywords: Depressed fracture; dural sinus injury; superior sagittal sinus injury.

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Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Computed tomography scan picture showing vertex epidural hemorrhage (b) with coronal suture diastases (a)
Figure 2
Figure 2
Three-dimensional computed tomography scan showing depressed fracture over midline over superior sagittal sinus
Figure 3
Figure 3
Three-dimensional computed tomography scan showing comminuted depressed fracture over anterior part of superior sagittal sinur area
Figure 4
Figure 4
Postoperative Three-dimensional scan showing burrhole sites for managing vertex extradural hematoma
Figure 5
Figure 5
Intra-operative photograph showing bilateral frontoparietal craniotomy leaving a strip of bone over midline and bilateral hitch stitches for control of sinus bleeding
Figure 6
Figure 6
Intraoperative photograph after repair of sinus tear by continuous suturing and reinforced with muscle patch
See this image and copyright information in PMC

References

    1. Cushing H. A study of series of wounds involving the brain and its enveloping structures. Br J Surg. 1918;5:558–684.
    1. Meirowsky AM. Wounds of dural sinuses. J Neurosurg. 1953;10:496–514. - PubMed
    1. Ozer FD, Yurt A, Sucu HK, Tektas S. Depressed fractures over cranial venous sinus. J Emerg Med. 2005;29:137–9. - PubMed
    1. Bonnal J, Buduba C. Surgery of the central third of the superior sagittal sinus. Experimental study. Acta Neurochir (Wien) 1974;30:207–15. - PubMed
    1. Datta SG, Ch M. Bilateral vertex extradural hematomas: A case report. Indian J Neurotrauma. 2008;5:109–11.