Delayed Neurological Deterioration after Depressed Fracture over Superior Sagittal Sinus: Our Experience with 13 Patients

Elshanawany, Ahmed M.; Ragab, Mahmoud H.

doi:10.1055/s-0039-1685189

Cited by 3 publications

(1 citation statement)

References 19 publications

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“…[21][22][23] However, delayed neurologic deterioration has been reported in up to 3 weeks postinjury when depressed fractures overlying the superior sagittal sinus were managed nonoperatively and, subsequently, required elevation due to raised intracranial pressure. 24 Venous sinus stenosis 25 and thrombosis 24,26 are precipitating factors.…”

Section: Surgical Indicationsmentioning

confidence: 99%

Variations in the Neurosurgical Management of Depressed Skull Fractures in Adults: An International Cross-Sectional Survey

Suliman

Jayakumar

Chaurasia³

et al. 2022

J Neurol Surg A Cent Eur Neurosurg

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Background and Study Aims Depressed skull fractures have been well-described since antiquity, yet its management remains controversial. Contentious issues include the use of prophylactic antibiotics and antiepileptics, the role of non-operative management, and the replacement/removal of bone fragments. Our objective was to explore the management patterns of closed and open depressed skull fractures across the world. Material and Methods A 23-item, web-based survey was distributed electronically to the members of national neurosurgical associations, and on social media platforms. The survey was open for data collection from December 2020-April 2021. Statistical calculations were performed with SPSS v22 (IBM). Results A total of 218 respondents completed the survey, representing 56 countries. With regards to open fractures, most respondents (85.8%) treated less than 50 cases annually. Most respondents (79.4%) offered prophylactic antibiotics to all patients with open fractures, with significant geographical variation (p<0.001). Less than half (48.2%) offered prophylactic antiepileptics. Almost all (>90%) reported the following indications as important for surgical management: (1) grossly contaminated wound; (2) dural penetration; (3) depth of depression; and (4) underlying contusion/haematoma with mass effect. Most respondents treated less than 50 cases of closed depressed skull fractures annually. Most European respondents (81.7%) did not offer prophylactic antiepileptics in comparison to most Asian respondents (52.7%) (p<0.001). Depth of depression, an underlying haematoma/contusion with mass effect, and dural penetration were the most important surgical indications. Conclusions There remains a great degree of uncertainty in the management strategies employed across the world in treating depressed fractures, and future work should involve multi-national randomised trials.

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Section: Surgical Indicationsmentioning

confidence: 99%

Variations in the Neurosurgical Management of Depressed Skull Fractures in Adults: An International Cross-Sectional Survey

Suliman

Jayakumar

Chaurasia³

et al. 2022

J Neurol Surg A Cent Eur Neurosurg

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Management of Compound Depressed Fractures over Venous Sinuses

Elbaroody,

Marei,

Sawy

et al. 2024

Asian J Neurosurg

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Objective The aim of this study was to report our experience in the surgical treatment of compound depressed fractures over the venous sinuses with special highlights on the prediction and dealing with intraoperative sinus injury. Materials and Methods We conducted a retrospective review of all patients who underwent surgery for compound depressed fractures overlying the dural venous sinuses in our hospital between January 2019 and December 2021. Results A total of 34 patients were included in our study. The mean age of the patients was 19.85 years, most of our patients were males 27 (79.4%), and isolated head trauma was the most common mode of trauma (76.5%). The superior sagittal sinus (SSS) was distinguished as the most commonly involved venous sinus below the fractures in 28 patients (82.4%). An intraoperative tear in the sinus was found in 17 patients (50%), which was easily controlled with different methods. In two patients who had a severe head injury with a Glasgow Coma Scale (GCS) score of ≤8 associated with a fissure fracture crossing the sinus, there was a complete tear of the sinus followed by massive bleeding, which required sinus ligation. We lost both of them in following days. Conclusion In experienced tertiary neurotrauma centers, compound depressed fractures over the venous sinuses should be surgically elevated in most cases, taking into consideration that bleeding from the sinus can be controlled in most cases, and complete tear of the sinus with massive bleeding is the least scenario faced in reality and is usually associated with a severe head injury. If expert opinion favors the conservative approach, then close follow-up for months is recommended due to the high possibility of sinus thrombosis and intracranial hypertension, especially in children.

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The Visual Threat of Intracranial Hypertension After Superior Sagittal Sinus Injury

Maestri,

Lefevre,

Krifa

et al. 2023

Journal of Neuro-Ophthalmology

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Delayed Neurological Deterioration after Depressed Fracture over Superior Sagittal Sinus: Our Experience with 13 Patients

Cited by 3 publications

References 19 publications

Variations in the Neurosurgical Management of Depressed Skull Fractures in Adults: An International Cross-Sectional Survey

Variations in the Neurosurgical Management of Depressed Skull Fractures in Adults: An International Cross-Sectional Survey

Management of Compound Depressed Fractures over Venous Sinuses

The Visual Threat of Intracranial Hypertension After Superior Sagittal Sinus Injury

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