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

Mathew, John; Sharma, Alok

doi:10.4103/2152-7806.69379

Cited by 6 publications

(8 citation statements)

References 10 publications

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“…Several authors have reported on penetrating injury to major intracranial vascular structures such as the basilar artery 3 and superior sagittal sinus. 11,12 Mathew and Sharma 11 reported on a shard of tile penetrating the anterior third of the sagittal sinus, which was able to be extracted with minimal blood loss after simple pressure on the sinus in a 7-year-old child. Sani and colleagues 12 report on an ingenious method of inserting a ''plug'' of temporalis muscle into the sinus perforation by tying it to the nail, which causes it to be inserted into the defect as the nail is withdrawn, which they accomplished in a 37-year-old man.…”

Section: Discussionmentioning

confidence: 98%

Penetrating Injury to the Superior Sagittal Sinus by a Nail in a 4-Year-Old Child

Sedney

Harshbarger

Orphanos

et al. 2012

Pediatric Emergency Care

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Penetrating head injuries are rare in children, with most injuries being accidental as a result of unsupervised use of sharp objects by young children. We present the case of a 4-year-old boy brought to our emergency department with a nail embedded through a wooden board and into his skull. The nail was determined to be entering the superior sagittal sinus through radiographic imaging. Thus, surgical removal of the nail was determined to be necessary. Inspection revealed a likely through-and-through injury to the sinus, and therefore, because sinus reconstruction was not deemed possible, the sinus was occluded with suture ties both in front and behind the nail before nail removal. Postoperatively, the patient did well and remained neurologically intact. Investigation for possible nonaccidental trauma was conducted. Although most commonly accidental in nature, nonaccidental penetrating traumas have been reported in both pediatric and adult populations. This patient did well after occlusion of his superior sagittal sinus at the coronal suture after penetrating injury by a nail. Penetrating injury in the pediatric population is predominantly thought to be accidental, but a high index of suspicion should be maintained for possible nonaccidental etiology.

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Section: Discussionmentioning

confidence: 98%

Penetrating Injury to the Superior Sagittal Sinus by a Nail in a 4-Year-Old Child

Sedney

Harshbarger

Orphanos

et al. 2012

Pediatric Emergency Care

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“…Surgical management of intracranial foreign bodies is not straightforward and must be assessed on a caseby-case basis (16,17). The standard management of penetrating intracranial injury is to fully assess the depth and location of the penetrating object with imaging, followed by a decision whether surgery is appropriate.…”

Section: Discussionmentioning

confidence: 99%

A Rare History: an Intracranial Nail Present for Over a Half-Century

Durmaz¹,

Özer

Çamlar

et al. 2017

Acta Med. (Hradec Kralove, Czech Repub.)

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We present a rare case of a patient with a persistent headache for many years found to have an intracranial nail present for nearly 65 years. The nail was found entering approximately 1 cm from the midline on the left side, passing below the superior sagittal sinus, with the tip 1.5 mm right of the frontal horn of the lateral ventricle. Treatment strategies designed to optimize outcome for intracranial foreign bodies and possible complications are discussed in this report. We also discuss the decision for surgical intervention for foreign bodies and the relevance of position of the foreign body.

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“…: 0000-0002-8530-7145 management, for example: venous sinus stenosis leading to venous hypertension and increased intracranial pressure (3,4,6,7,(18)(19)(20), sinus thrombosis leading to late deterioration (11), benign intracranial hypertension (3,6,7,20), and even hemorrhagic infarction (13).…”

Section: Mohamed Mostafa Azizmentioning

confidence: 99%

“…Depressed calvarial fractures overlying the major venous sinus with the absence of a CSF fistula or an associated intracranial hematoma are often managed conservatively because of the associated high risks of major sinus bleeding, especially if a depressed bone fragment has been closing a sinus tear or sinus occlusion and venous infarction (1,11). Elevating depressed skull fractures overlying a cranial venous sinus is hazardous (18).…”

Section: Treatment and Outcomementioning

confidence: 99%

“…However, not all cases can be treated conservatively as some cases may involve foreign bodies (11). The surgical management of depressed fractures is indicated when a venous sinus has been occluded by the depressed bone resulting in increased intracranial pressure (19), and might also be needed in rare circumstances of delayed intracranial hypertension (3,7).…”

Section: Treatment and Outcomementioning

confidence: 99%

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Depressed skull fractures overlying dural venous sinuses: management modalities and review of literature.

Aziz

Molla²,

Abdelrahiem³

et al. 2019

Turkish Neurosurgery

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AIM: To characterize the sociodemographic, clinical and radiological findings of patients with depressed skull fractures overlying cranial dural sinuses that we have faced in our institute. In addition, to explore the indications and choices for the surgical and nonsurgical management of such cases, and assess outcomes in these two treatment groups. MATERIAL and METHODS: We prospectively followed up a cohort of 34 patients with fractures over dural venous sinuses from January 2013 to December 2017. Twelve (35.1%) were simple depressed fractures (SDFs) and 22 (64.7%) were compound depressed fractures (CDFs). Eighteen patients (52.9%) were treated surgically, and 16 (47.1%) were treated conservatively. RESULTS: The mean age was 20.8 years. Thirty-two of the patients were males (94.12%). The mean time from trauma until hospital arrival was 3.8 hours, and the mean admission Glasgow Coma Score (GCS) was 13.7. Direct trauma was the most common mode of injury. Funduscopy was performed in 16 patients (47.1%), and magnetic resonance venography (MRV) in four patients (11.8%). Twenty-four patients (70.59%) had the fracture overlying the superior sagittal sinus (SSS). The mean length of hospital stay was five days, and the mean follow-up duration was 6.8 months. Twenty-eight patients (82.35%) had a good recovery. CONCLUSION: The majority of SDFs and some CDFs overlying dural sinuses can be managed safely without major surgical intervention. Conservation should be favored when the sinus is patent, dura intact, and bone displacement is insignificant in neurologically intact patients with an apparently clean wound. Otherwise, surgery should be considered. We also propose including a funduscopic examination and venogram as parts of the initial trauma work-up for these patients.

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

Cited by 6 publications

References 10 publications

Penetrating Injury to the Superior Sagittal Sinus by a Nail in a 4-Year-Old Child

Penetrating Injury to the Superior Sagittal Sinus by a Nail in a 4-Year-Old Child

A Rare History: an Intracranial Nail Present for Over a Half-Century

Depressed skull fractures overlying dural venous sinuses: management modalities and review of literature.

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