Korean J Neurotrauma.  2018 Oct;14(2):150-154. 10.13004/kjnt.2018.14.2.150.

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

• Kim JH
• Yu SH
• Kim BC
• Lee JH
• Lee JI
• Choi HJ

• KMID: 2424330
• DOI: http://doi.org/10.13004/kjnt.2018.14.2.150

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.

Keyword

Intracranial epidural hematoma; Posterior cranial fossa; Therapeutic embolization

MeSH Terms

Accidental Falls
Angiography
Brain
Colon, Sigmoid
Cranial Fossa, Posterior
Craniotomy
Embolization, Therapeutic
Epidural Space
Hematoma
Hematoma, Epidural, Cranial
Hemorrhage*
Humans
Lacerations
Male
Middle Aged
Mortality
Operating Rooms

Figure

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  FIGURE 1 The 57-year-old male admitted after falling from a three-story building. (A) The initial computed tomography scan showed right posterior temporal and cerebellar extradural haemorrhage with mass effect and shifting. (B) Right temporal and occipital bone fractures were showed.

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  FIGURE 2 (A) Postoperative computed tomography scan confirmed radiopaque gauze in the epidural space. (B) Skull X-ray showed radiopaque gauze in the cranial space.

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  FIGURE 3 (A) A conventional angiography showed patent distal flow of right transverse sinus with mild stenosis. (B) Postembolization angiogram showed no sign of the contrast leakage and venous hypertension.

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  FIGURE 4 The 2nd postoperative computed tomography scan showed total removal of extradural haemorrhage and no sign of and venous hypertension.

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