Depressed Fracture Over Superior Sagittal Sinus: Management Outcome In Qena University Hospitals

Mahmoud, Radwan Nouby; Kamel, Ali Rabee; Hassan, Eslam Elsayed; Abdulaziz, Mohamed Ahmed

doi:10.21608/svuijm.2023.233465.1681

Depressed Fracture Over Superior Sagittal Sinus: Management Outcome In Qena University Hospitals

Document Type : Original research articles

Authors

¹ Neurosurgery Department, Faculty of Medicine, Assiut University, Assiut, Egypt

² Neurosurgery Department, Faculty of Medicine, South Valley University, Qena, Egypt

10.21608/svuijm.2023.233465.1681

Abstract

Background: Depressed skull fractures that lie over dural venous sinuses have the potential to lacerate or compress these sinuses resulting in massive bleeding or intracranial hypertension, non-surgical management may allow sinus thrombosis or stenosis and subsequent venous infarction or intracranial hypertension to occur. Surgical management with sinus reconstruction or repair is now advocated.
Objectives: to assess the outcome of management of patients with skull depressed fractures over superior sagittal sinus in Qena university hospitals.
Patients and methods: hospital-based Cohort study conducted on 30 patients admitted with depressed skull fractures over superior sagittal sinus to Neurosurgery Department, Qena University Hospital. The patients data were collected including demographic data, mode of trauma, vital signs, they were subjected to neurological evaluation of the conscious level and the motor power preoperatively using Glasgow coma scale and Muscle power scale respectively .Radiological assessment was done using CT scan to evaluate the pattern of the fracture ,the site and its relation to the sagittal sinus. Magnetic resonance imaging (MRI) and Magnetic resonance venograohy(MRV) were ordered only for patients who developed signs of superior sagittal sinus thrombosis. Patients were managed either conservative or surgical including evaluation elvation of the fracture, sinuorraphy or hitch stiches to control the sinus bleeding. Postoperatively the outcome was evaluated using the Glasgow coma scale, the Motor power scale and Extended Glasgow outcome scale.
Results: Out of 30 patients with depressed skull fractures related to the superior sagittal sinus we found that there were significant male predominance about 93.3%, assault was the most common mode of trauma 70%. Surgical intervention was chosen for 90% of patients while 10% of patients were managed conservatively. As regard Glasgow coma score (GCS)80% of patients showed improvement post operatively. While 87.5% of patients showed significant improvement in their motor power, and as regard Glasgow outcome score Extended (GOS-E) 74.1% of patients who had undergone surgery had upper good recovery while only one patient 3.7%had upper moderate disability.
Conclusion: In conclusion, surgical management of depressed fractures overlying the superior sagittal sinus should be strongly considered especially when there are venous sinus compression, neurological deficit or scalp wound over the fracture site. Venous sinus thrombosis must be taken into account when evaluating patients with simple depressed fracture over or near the superior sagittal sinus.

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