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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

Intraoperative photograph after repair of sinus tear by continuous suturing and reinforced with muscle patch
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Figure 6: Intraoperative photograph after repair of sinus tear by continuous suturing and reinforced with muscle patch

Mentions: There occurred significant amount of bleeding in all cases. In four cases with vertex EDH managed with fronto-parietal craniotomy extending to either side of midline and hence that sinus injury was dealt under direct vision [Figure 4], but in 2 cases we performed bilateral fronto-parietal craniotomy leaving a strip of bone in midline over the SSS area so that bilateral hitch stitches over gel foam was given to control bleeding from sinus [Figure 5]. In two cases with depressed fractures over sinus area with large sinus tear, circumferential craniectomy was done extending to either side of sinus area and direct suture repair of sinus was done, which was further reinforced with muscle patch [Figure 6].


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)

Intraoperative photograph after repair of sinus tear by continuous suturing and reinforced with muscle patch
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 6: Intraoperative photograph after repair of sinus tear by continuous suturing and reinforced with muscle patch
Mentions: There occurred significant amount of bleeding in all cases. In four cases with vertex EDH managed with fronto-parietal craniotomy extending to either side of midline and hence that sinus injury was dealt under direct vision [Figure 4], but in 2 cases we performed bilateral fronto-parietal craniotomy leaving a strip of bone in midline over the SSS area so that bilateral hitch stitches over gel foam was given to control bleeding from sinus [Figure 5]. In two cases with depressed fractures over sinus area with large sinus tear, circumferential craniectomy was done extending to either side of sinus area and direct suture repair of sinus was done, which was further reinforced with muscle patch [Figure 6].

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