Endovascular Treatment Following Gauze Packing for the Control of Massive Bleeding from Traumatic Transverse Sinus Lesion

Abstract

Posterior fossa epidural hematoma (EDH) is uncommon, but the related clinical deterioration can occur suddenly. Accompanying venous sinus injury and lacerations are associated with 40% to 80% mortality. The authors present one clinical case of a patient with posterior fossa EDH from transverse sinus bleeding. A 57-year-old male was injured after falling while working. He was taken to the hospital, where computed tomography scans of his brain revealed a right posterior temporal and cerebellar EDH with a right temporo-occipital fracture. He underwent a right parieto-occipital craniotomy, incorporating the fracture line. Longitudinal laceration of the right transverse sinus extending to the sigmoid sinus with profuse bleeding was identified. Four gauzes were inserted in the epidural space for tamponade of the injured sinus. Conventional angiography and coil embolization for the injured sinus were immediately performed. Subsequently, the patient was transferred to the operating room, wherein staff members removed the gauzes and remnant hematoma. Based on this experience, the authors recommend that for posterior fossa EDH from transverse sinus bleeding, bleeding control should be performed by gauze packing and endovascular treatment.

Gauze Packing for the Massive Venous Sinus Bleeding in a Patient with Acute Subdural Hematoma of Posterior Fossa

“…This method was not only prompt, but also safe, as there was no significant intraparenchymal haemorrhage around the gauze, ischemic lesion or mass effect against the brain stem on the brain CT after the first operation. This method has been used for a long time; a recent report has documented a successful application of this method to control a severe venous sinus bleeding in a patient with acute epidural hematoma 1)…”

“…If the sinus is not occluded after the gauze packing, it can be occluded using the coil embolization technique before the second operation to prevent the dangerous rebleeding after the consideration of the benefit to risk ratio for the sinus embolization 1). The acute venous sinus occlusion can cause several complications, such as venous infarction, intracranial hemorrhage, edema, subarachnoid hemorrhage, as well as rapidly progressive illness and coma 1). According to a recent report, the venous sinus remained patent three days after the operation of acute epidural hematoma removal and gauze packing 1).…”

“…The acute venous sinus occlusion can cause several complications, such as venous infarction, intracranial hemorrhage, edema, subarachnoid hemorrhage, as well as rapidly progressive illness and coma 1). According to a recent report, the venous sinus remained patent three days after the operation of acute epidural hematoma removal and gauze packing 1). To prevent a dangerous rebleeding, the operators successfully occluded the injured sinus using the coil embolization technique.…”