Depressed Occipital Skull Fracture With Associated Sagittal Sinus Occlusion

Resolution of Intracranial Hypertension after Elevation of Depressed Cranial Fracture over the Superior Sagittal Sinus:Case Report

“…Conventional neurosurgical wisdom dictates that the fracture should not be elevated because of the risk of fatal hemorrhage (1,7,8). However, some published cases document safe fracture elevation over the SSS with clinical and radiographic resolution (4,6,14,22). In support, we report the case of a patient with DCF over the posterior third of the SSS leading to signs and symptoms of secondary intracranial hypertension, which resolved after fracture elevation.…”

“…In addition to local pain and tenderness associated with the traumatic insult, a variety of neurological deficits have been associated with SSS obstruction from a DCF, including obtundation, papilledema, altered visual acuity, nausea and vomiting, and sensorimotor dysfunction (6,13,14,20,22,23); these findings commonly are observed in patients with secondary intracranial hypertension (2,5,10). In our patient, persistent headache accompanied by abducens and trochlear palsies, aural hum, and severe papilledema were noted.…”

“…In a patient with homonymous hemianopsia and bilateral papilledema caused by a parietal DCF, surgical elevation led to prompt resolution of symptoms (22). Elevation of an occipital DCF in a 13-year-old boy with headache, emesis, and hyponatremia (14) led to complete resolution of symptoms within 7 days, and follow-up imaging verified SSS recanalization at 6 months (14).…”

“…As part of a standard trauma evaluation, a noncontrast head CT scan should reveal the DCF. Sinus patency can be evaluated by magnetic resonance imaging (13,14,22,23). Magnetic resonance venography, in particular, provides detailed information regarding the site of obstruction, indirect indications of the degree of flow, and the presence or absence of thrombus (17,19,22,23), and it can be used to observe the development of collateral circulation after a prolonged period of venous occlusion (23).…”

Midline depressed skull fracture presenting with quadriplegia: A rare phenomenon

“…[7] However, some authors have reported persistence of features of benign intracranial hypertension (BIH) with conservative measures, ultimately requiring surgical intervention (elevation of bone fragment) in their patients. [4] In addition, if untreated, the thrombosis can extend proximally or distally leading to venous infarction, which is irreversible. [8] However, it should be borne in mind that surgical intervention should be individualized for each patient's clinical condition and weighed against its risks.…”