Resolution of intracranial hypertension after elevation of depressed cranial fracture over the superior sagittal sinus: case report.

نویسندگان

  • Devin K Binder
  • Vahé Sarkissian
  • Meic H Schmidt
  • Lawrence H Pitts
چکیده

OBJECTIVE AND IMPORTANCE It is common neurosurgical wisdom that depressed cranial fractures (DCFs) over the superior sagittal sinus (SSS) should not be elevated because of the risk of fatal venous hemorrhage. CLINICAL PRESENTATION A 34-year-old man presented with severe headache and diplopia after a motor vehicle accident. Clinical examination demonstrated severe papilledema and bilateral abducens palsy. Imaging findings demonstrated a DCF over the posterior third of the SSS and absent flow distal to the fracture with dilated cortical venous drainage. INTERVENTION Conservative treatment with acetazolamide only partially alleviated the patient's headache and diplopia. Definitive surgical treatment via elevation of the DCF was discussed and decided upon. Twelve days after injury, the patient underwent midline parieto-occipital craniotomy with successful elevation of the DCF off the posterior third of the SSS. Postoperative magnetic resonance venograms revealed restoration of patency in the SSS with reduced tortuosity of cortical veins. The patient's headache resolved, and his papilledema and diplopia resolved gradually. CONCLUSION Elevation of DCF over the SSS can be attempted in cases in which favorable bone anatomy and the patient's clinical condition warrant. This may result in rapid and dramatic resolution of signs and symptoms of secondary intracranial hypertension.

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

منابع مشابه

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

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...

متن کامل

Open Depressed and Compound Elevated Skull Fracture over the Superior Sagittal Sinus: A Case Report

This is a case report of an open depressed and compound elevated skull fracture that located in the area where superior sagittal sinus lies beneath. This is a very rare variant of skull fractures. This patient was admitted to our Department of Neurosurgery Hasan Sadikin Hospital, Bandung Indonesia. He is a 14 years old male with motor vehicle accident and diagnosed with compound elevated and de...

متن کامل

Dural sinus thrombosis following head injury: report of two cases and review of the literature.

Dural sinus thrombosis (DST) usually involves the sagittal, transverse and sigmoid sinuses and is more common in women due to pregnancy, puerperium and oral contraceptive use. Other etiologies include coagulopathies, infection and head injury. We have present two DST cases following head injury. The first case was a 35-year-old man hospitalized because of one-week history of headache and repeat...

متن کامل

CSF hydrodynamics in superior sagittal sinus thrombosis.

Cerebrospinal fluid hydrodynamics were investigated with a constant pressure infusion method in patients with superior sagittal sinus thrombosis. Ten patients were studied with serial examinations up to 15 years after the onset of the disease. A total of 70 CSF hydrodynamic examinations were performed. A clear increase in intracranial pressure due to raised pressure in the major dural sinus was...

متن کامل

ذخیره در منابع من


  با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

عنوان ژورنال:
  • Neurosurgery

دوره 55 4  شماره 

صفحات  -

تاریخ انتشار 2004