Traumatic Dural Venous Sinuses Injury

A brief review of dural venous sinus injury with a short case series

Background

Dural venous sinus injury results in torrential hemorrhage and exsanguination. The initial review by Harvey Cushing had shown high mortality. The depressed fractures over sinuses were managed conservatively, because of the risk of massive hemorrhage during elevation. The consequences of sinus injury are hemorrhage, intracranial hypertension, brain swelling and venous infarct. Topical hemostatic agents such as gelatin sponge, oxidized cellulose, hemostatic matrix, bioresorbable plate, tissue-glue-coated collagen sponge, and fibrin glue help in controlling bleeding during surgery. The aim of the study is to analyze five cases of traumatic dural venous sinus injury. The literature review was done from Pubmed, Scopus and Google Scholar. A retrospective and descriptive analysis is done.

Case presentation

Among the five cases described, four had injury to superior sagittal sinus and one had injury to the transverse sinus. Two patients had open wounds. Three patients had continuous bleeding and two had intracranial hypertension. Decompressive craniectomy was done in three patients, wound hemostasis and closure in one, and craniotomy and evacuation of hematoma in one. Compression with Gelfoam was the main method for hemostasis and thrombin–gelatin hemostatic matrix had to be applied in two patients, with continued pressure for one hour.

Conclusions

Injury to the dural venous sinus should be suspected in fracture over the venous sinus. Surgery is indicated in active bleeding, expanding hematoma, compression or occlusion of the sinus and intracranial hypertension. Topical hemostatic agents help in controlling the bleed. Morbidity and mortality are more with involvement of middle and posterior third of superior sagittal sinus.

Penetrating Injury of Superior Sagittal Sinus

Penetrating injury of superior sagittal sinus (SSS) is very rare yet serious which can lead to morbidity and mortality. Complications such as bleeding, thrombosis, and infection are possible and should be anticipated. We report a case of 3-year-old boy with penetrating injury caused by a nail at the middle third of SSS. The patient underwent the surgery for extraction and sinus repair and antibiotic treatment during the hospital stay. He was neurologically intact and recovered completely. Comprehensive treatment of both surgical and medical management is important in achieving the best possible outcome.