Article
Surgical management of bony fractures involving the dural venous sinus
Verletzungen venöser Sinus durch knöcherne Frakturen – Chirurgische Versorgung
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Authors
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M. Ortler
- Universitätsklinik für Neurochirurgie, Medizinische Universität Innsbruck, Österreich
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K. Twerdy
- Universitätsklinik für Neurochirurgie, Medizinische Universität Innsbruck, Österreich
| Published: | April 11, 2007 |
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Outline
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Objective: Surgical intervention in fractures over a venous sinus is controversial, ranging from therapeutic nihilism to extensive vascular reconstruction. We present our experience with posttraumatic venous sinus repair.
Methods: Retrospective review of all patients with bony fractures involving major venous sinus treated between 1980 and 2005 at a tertiary neurotrauma center. Type of injury, clinical presentation, localization of sinus injury, techniques used for sinus repair and clinical outcome were evaluated. Until submission of this abstract, data regarding 31 patients were analyzed and outcome analysis is under way.
Results: The majority of injuries were the result of alpine outdoor activities (n=15). Five fracture were closed fractures, all others were open fractures. The sagittal sinus was involved in 25 patients (anterior third n=7, middle third n=10, posterior third n=8), the confluens sinuum in two, the transverse sinus sinus in two and the sinus knee in two patients. Techniques of sinus repair included simple tamponade (n=11), tamponade aided by fibrin glue (n=3), suturing (n=3), coagulation of rents (n=3) or bridging veins(n=2), tracking sutures (n=2), waxing of bony emissaries (n=2) and sinus ligature (n=1). In one patient, the type of repair could not be evaluated and in three patients the sinus was not injured. In all patients the outcome was dependent on the primary and secondary brain injury and on coexisting injuries in polytraumatized patients.
Conclusions: Surgical intervention in skull fractures involving major venous sinuses is safe provided standard techniques of vascular sinus repair are employed. Surgery permits wound debridement in open injuries, minimizes the risk of intracranial venous hypertension and probably shortens the hospital stay.
