Korean J Neurotrauma.  2019 Oct;15(2):164-169. 10.13004/kjnt.2019.15.e30.

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

• Yang TK

• KMID: 2461122
• DOI: http://doi.org/10.13004/kjnt.2019.15.e30

Abstract

A 57-year-old male had cardiac arrest during an operation of traumatic acute subdural haematoma (ASDH) and intraparenchymal haemorrhage in the infratentorium due to a great amount of bleeding from the pre-injured venous sinus. After effective bleeding control using a gauze, the patient recovered without additional neurological sequelae. The operation of traumatic ASDH in the infratentorium always poses a risk of excessive bleeding from the injured venous sinus that could be life-threatening to the patient. This risk could be avoided with the effective first method that can immediately control the bleeding.

Keyword

Acute subdural haematoma; Infratentorium; Venous sinus; Bleeding control; Gauze

MeSH Terms

Heart Arrest
Hematoma, Subdural, Acute*
Hemorrhage*
Humans
Male
Methods
Middle Aged

Figure

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  FIGURE 1 A brain computerized tomography scan from the first hospital shows a small amount of acute subdural haematoma in the right infratentorium (arrows).

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  FIGURE 2 The brain computerized tomography scan checked in the intensive care unit after the deterioration of mentality reveals a newly developed intraparenchymal haemorrhage and an increased amount of acute subdural haematoma.

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  FIGURE 3 The postoperative brain computerized tomography exhibits the hyperdense gauze shadow with radiopaque markers (arrows), but no significant intraparenchymal haemorrhage, ischemic lesion, or mass effect against brain stem.

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  FIGURE 4 (A) The enhanced brain computerized tomography before the second operation shows occlusion of transverse sinus at the distal end (arrow). (B) The cerebral angiography before the second operation shows no contrast filling from the distal end of the right transverse sinus (arrow).

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  FIGURE 5 The review of the brain computerized tomography images with bone setting windows checked at the first hospital reveals a diastatic fracture of the right occipitomastoid suture (arrow).

Reference

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