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

Behera SK, Senapati SB, Mishra SS, Das S - Asian J Neurosurg (2015 Jan-Mar)

Bottom Line: 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.Preoperative suspicion and combination of surgical techniques rather than one single technique may be effective in decreasing the sinus related mortality rate.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, S.C.B. Medical College and Hospital, Cuttack, Odisha, India.

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.

No MeSH data available.


Related in: MedlinePlus

Three-dimensional computed tomography scan showing comminuted depressed fracture over anterior part of superior sagittal sinur area
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Figure 3: Three-dimensional computed tomography scan showing comminuted depressed fracture over anterior part of superior sagittal sinur area

Mentions: In a period of 1-year (August 2011 to July 2012) of 549 cases of head injuries operated in our department analysis of 15 cases (2.73%) shown to have SSS injury encountered intraoperatively. Road traffic accident was the cause in 11 cases (73.34%), assault in 3 cases (20%) and fall of a heavy object overhead in 1 case (6.67%). All the patients are initially investigated with computed tomography (CT) scan with three-dimensional reconstruction, routine hemogram and coagulation studies. A possible SSS injury was suspected in all cases with vertex epidural hemorrhage (EDH) with coronal suture diastases [Figure 1] and in patients with fracture line extending to sinus area and with depressed fracture over midline [Figures 2 and 3]. Those patients who were planned for surgery are prepared with an extra unit of blood and fresh frozen plasma.


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

Behera SK, Senapati SB, Mishra SS, Das S - Asian J Neurosurg (2015 Jan-Mar)

Three-dimensional computed tomography scan showing comminuted depressed fracture over anterior part of superior sagittal sinur area
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4352622&req=5

Figure 3: Three-dimensional computed tomography scan showing comminuted depressed fracture over anterior part of superior sagittal sinur area
Mentions: In a period of 1-year (August 2011 to July 2012) of 549 cases of head injuries operated in our department analysis of 15 cases (2.73%) shown to have SSS injury encountered intraoperatively. Road traffic accident was the cause in 11 cases (73.34%), assault in 3 cases (20%) and fall of a heavy object overhead in 1 case (6.67%). All the patients are initially investigated with computed tomography (CT) scan with three-dimensional reconstruction, routine hemogram and coagulation studies. A possible SSS injury was suspected in all cases with vertex epidural hemorrhage (EDH) with coronal suture diastases [Figure 1] and in patients with fracture line extending to sinus area and with depressed fracture over midline [Figures 2 and 3]. Those patients who were planned for surgery are prepared with an extra unit of blood and fresh frozen plasma.

Bottom Line: 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.Preoperative suspicion and combination of surgical techniques rather than one single technique may be effective in decreasing the sinus related mortality rate.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, S.C.B. Medical College and Hospital, Cuttack, Odisha, India.

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.

No MeSH data available.


Related in: MedlinePlus