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Bizarre depressed skull fracture by a tile fragment in a young child, causing superior sagittal sinus injury.

Mathew JE, Sharma A - Surg Neurol Int (2010)

Bottom Line: A 7-year-old child presented with a tile fragment embedded in the skull, penetrating SSS.This ensured a favorable outcome.This case illustrates that even in such a scenario, adherence to neurosurgical principles can ensure a good outcome.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Neurosurgery, Christian Medical College, Ludhiana - 141 008, Punjab, India.

ABSTRACT

Background: Head injuries following fall from height are not very uncommon in developing countries due to a lack of safety standards. We describe this bizarre injury by a tile fragment penetrating the superior sagittal sinus (SSS) and its successful surgical management.

Case description: A 7-year-old child presented with a tile fragment embedded in the skull, penetrating SSS. Urgent exploration and removal of the foreign body was done to prevent complications like infection and delayed development of intracranial hypertension. Although bleeding from the SSS was a problem, this was tackled by raising the head end and giving pressure with Surgicel and Gelatine sponge. This ensured a favorable outcome.

Conclusion: Although compound depressed fractures of the SSS are managed conservatively due to the risk of fatal venous hemorrhage, the unique nature of the injury in this case warranted surgical management. This case illustrates that even in such a scenario, adherence to neurosurgical principles can ensure a good outcome.

No MeSH data available.


Related in: MedlinePlus

Intraoperative view showing the epidural hematoma around the FB
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Figure 0005: Intraoperative view showing the epidural hematoma around the FB

Mentions: Lateral skull X-rays and computed tomography (CT) of the head revealed that the foreign body (FB) had penetrated 1.5 cm deep to the inner table through a fracture of the skull in the midline [Figures 3 and 4]. We suspected penetration of the SSS. He was taken up for urgent exploration and removal of the FB. Head end was raised about 30° and continuous saline irrigation was done while a burr hole and craniectomy was done around the FB. There was extradural clot around the FB [Figure 5]. On carefully removing the FB, there was bleeding from the SSS which was controlled with Gelfoam, Surgicel and pressure. After washing the wound, it was closed in layers over a drain. No anticoagulant therapy was used in the peri-operative period. Postoperative period was uneventful and he had no neurological deficits, evidence of infection or symptoms of raised intracranial pressure (suggestive of SSS thrombosis) at the time of discharge. The family was advised to bring the child for cranioplasty at a later date. However, he was lost to follow-up.


Bizarre depressed skull fracture by a tile fragment in a young child, causing superior sagittal sinus injury.

Mathew JE, Sharma A - Surg Neurol Int (2010)

Intraoperative view showing the epidural hematoma around the FB
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2958324&req=5

Figure 0005: Intraoperative view showing the epidural hematoma around the FB
Mentions: Lateral skull X-rays and computed tomography (CT) of the head revealed that the foreign body (FB) had penetrated 1.5 cm deep to the inner table through a fracture of the skull in the midline [Figures 3 and 4]. We suspected penetration of the SSS. He was taken up for urgent exploration and removal of the FB. Head end was raised about 30° and continuous saline irrigation was done while a burr hole and craniectomy was done around the FB. There was extradural clot around the FB [Figure 5]. On carefully removing the FB, there was bleeding from the SSS which was controlled with Gelfoam, Surgicel and pressure. After washing the wound, it was closed in layers over a drain. No anticoagulant therapy was used in the peri-operative period. Postoperative period was uneventful and he had no neurological deficits, evidence of infection or symptoms of raised intracranial pressure (suggestive of SSS thrombosis) at the time of discharge. The family was advised to bring the child for cranioplasty at a later date. However, he was lost to follow-up.

Bottom Line: A 7-year-old child presented with a tile fragment embedded in the skull, penetrating SSS.This ensured a favorable outcome.This case illustrates that even in such a scenario, adherence to neurosurgical principles can ensure a good outcome.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Neurosurgery, Christian Medical College, Ludhiana - 141 008, Punjab, India.

ABSTRACT

Background: Head injuries following fall from height are not very uncommon in developing countries due to a lack of safety standards. We describe this bizarre injury by a tile fragment penetrating the superior sagittal sinus (SSS) and its successful surgical management.

Case description: A 7-year-old child presented with a tile fragment embedded in the skull, penetrating SSS. Urgent exploration and removal of the foreign body was done to prevent complications like infection and delayed development of intracranial hypertension. Although bleeding from the SSS was a problem, this was tackled by raising the head end and giving pressure with Surgicel and Gelatine sponge. This ensured a favorable outcome.

Conclusion: Although compound depressed fractures of the SSS are managed conservatively due to the risk of fatal venous hemorrhage, the unique nature of the injury in this case warranted surgical management. This case illustrates that even in such a scenario, adherence to neurosurgical principles can ensure a good outcome.

No MeSH data available.


Related in: MedlinePlus