Traumatic open depressed cranial fracture causing occlusion of posterior superior sagittal sinus

Abstract

Rationale:The superior sagittal sinus (SSS) is the major dural sinuses that receive a considerable amount of venous drainage. Interruption of its posterior third has been suggested to cause intracranial hypertension and lead to potentially fatal consequences.Patient concerns:We presented a 22-year-old man with a severe headache and scalp bleeding after a head chop wound. Physical examination identified a 20-cm straight laceration in his parietooccipital scalp. Computed tomography (CT) demonstrated a depressed cranial fracture (DCF) in the left parietooccipital bone, a fracture line across the midline to the right side, and penetrations of bone fragments into the brain parenchyma.Diagnoses:Traumatic open DCF in left parietooccipital bone.Interventions:An emergent left parietooccipital craniotomy, followed by cranioplasty to restore the depressed bone flap, was delivered to the patient. Postoperative CT confirmed successful elevation of the DCF and removal of intracerebral bone fragments. However, postoperative CT angiography (CTA) demonstrated an absence of venous flow distal to the fracture, suggesting occlusion of the posterior third of SSS. MRV revealed a persistent absence of venous flow in the posterior third of SSS with dilated cortical venous drainage. Anticoagulation treatment was initiated 3 days after surgery, and follow-up CTA and digital subtraction angiography showed gradually improved patency in the anterior and middle two-thirds of SSS.Outcomes:Despite occlusion of the posterior third of SSS, patient's symptoms resolved after the operation and he was discharged without complications.Lessons:The favorable clinical outcome after complete occlusion of the posterior third of the SSS has rarely been reported and it might be explained by our timely surgical intervention and development of compensatory cerebral collateral circulation.

Comparative Therapeutic Effectiveness of Anticoagulation and Conservative Management in Traumatic Cerebral Venous Sinus Thrombosis

“…19-21 Case reports suggest that AC can be safe and effective in tCVST, similar to its more established role in sCVST. 14,22-29 This study suggests that AC treatment in tCVST may lead to higher rates of complete thrombus recanalization when compared with conservative management.…”

“…[19][20][21] Case reports suggest that AC can be safe and effective in tCVST, similar to its more established role in sCVST. 14,[22][23][24][25][26][27][28][29] This study suggests that AC treatment in tCVST may lead to higher rates of complete thrombus recanalization when compared with conservative management. The goal of AC treatment in CVST is to prevent thrombus progression and ultimately promote clot resolution.…”

Cerebral venous revascularization in meningioma surgery

“…В дальнейших исследованиях следует уточнить показания и противопоказания к данной хирургии, а также прояснить оперативную технику вмешательства. При этом стоит иметь в виду, что техника венозной реваскуляризации может использоваться при лечении других нейрохирургических патологийострой травмы синусов, артериовенозных фистул, аневризм [63][64][65][66].…”