Korean J Neurotrauma.  2015 Oct;11(2):118-123. 10.13004/kjnt.2015.11.2.118.

Traumatic Dural Venous Sinus Injury

• Kim YS
• Jung SH
• Lim DH
• Kim TS
• Kim JH
• Lee JK

• KMID: 2378269
• DOI: http://doi.org/10.13004/kjnt.2015.11.2.118

Abstract

OBJECTIVE
The importance of traumatic dural venous sinus injury lies in the probability of massive blood loss at the time of trauma or emergency operation resulting in a high mortality rate during the perioperative period. We considered the appropriate methods of treatment that are most essential in the overall management of traumatic dural venous sinus injuries.
METHODS
We conducted a retrospective review of all cases involving patients with dural venous sinus injury who presented to our hospital between January 1999 and December 2014.
RESULTS
Between January 1999 and December 2014, 20 patients with a dural venous sinus injury out of the 1,200 patients with severe head injuries who had been operated upon in our clinic were reviewed retrospectively. There were 17 male and 3 female patients. In 11 out of the 13 patients with a linear skull fracture crossing the dural venous sinus, massive blood loss from the injured sinus wall could be controlled by simple digital pressure using Gelfoam. All 5 patients with a linear skull fracture parallel to the sinus over the venous sinus developed massive sinus bleeding that could not be controlled by simple digital pressure.
CONCLUSION
When there is a linear skull fracture parallel to the sinus over the dural venous sinus or a depressed skull fracture penetrating the sinus, the surgeon should be prepared for the possibility of potentially fatal venous sinus injury, even in the absence of a hematoma.

Keyword

Cranial sinus; Skull fractures; Superior sagittal sinus; Injury

MeSH Terms

Craniocerebral Trauma
Emergencies
Female
Gelatin Sponge, Absorbable
Hematoma
Hemorrhage
Humans
Male
Mortality
Perioperative Period
Retrospective Studies
Skull Fracture, Depressed
Skull Fractures
Superior Sagittal Sinus

Figure

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  FIGURE 1 Computed tomography scan of the head showing a depressed fracture penetrating the superior sagittal sinus (A) and hemorrhagic contusion of the parenchyma (B).

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  FIGURE 2 Computed tomography scan showing an open compound depressed skull fracture overlying the anterior part of the superior sagittal sinus in the region of the left frontal bone (A) with hemorrhagic contusions (B).

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  FIGURE 3 Skull X-ray revealed a right occipital skull fracture parallel to sigmoid sinus (white arrow).

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  FIGURE 4 Computed tomography of the head showing a right occipital skull fracture (A) and epidural and subdural hematoma causing mass effect with compression and displacement of the fourth ventricle (B).

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  FIGURE 5 Skull X-ray showing a multiple linear, depressed skull fractures of the vertex crossing the middle part of the superior sagittal sinus (white arrows).

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  FIGURE 6 Brain computed tomography revealed a huge epidural hemorrhage along both high frontoparietal lobes with mass effect and midline shift.

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