Compound depressed skull fractures overlying dural venous sinuses

ABSTRACT

The purpose of this study was to characterize the patients with compound depressed skull fractures overlying dural venous sinuses clinically, radiologically and to discuss the patients' circumstances that favour conservative or surgical treatment in addition to the outcome. Of 192 patients with depressed skull fractures admitted to Neurosurgical Department, Assiut University hospital between January 2004 to December 2005, Thirty patients [15.6%] with compound depressed skull fractures over a dural venous sinus were prospectively studied, They were 27 [90%] males and 3 [10%] females. Regard the age, 18 [60%] were pediatrics [3-18 yrs.] while, 12 [40%] were adults [20-60yrs.]. Twenty-four patients had a Glasgow Coma Scale [GCS] of 14-15/15, while a GCS was 9-13 and <8 in 3 patients for each. Etiologically falls and motor vehicle accident were predominant in pediatric group while, among adults assault and motor vehicle accident were predominant. The superior saggital sinus was the most commonly involved sinus [28 out of 30 patients=93.3%] with anterior injuries more common than posterior one [26 out of 28 patients = 92.9%]. Thirteen patients [43.3%] were treated conservatively and 17 [56.7%] patients were treated surgically either initially in 15 cases due to the presence of neurological deficit, underlying haematoma, egress or escape of intracranial contents and/or deep contamination or later on in 2 cases due to development of intracranial hypertension. Intraoperative difficulty was experienced in 8 [47.1%] patients. Of those treated non-operatively 3 [23.1%] patients developed wound infection, while wound infection among those treated operatively was in 2 [11.8%] patients. No mortality occured, and the neurological deficit was reversed with the aid of physiotherapy by time and the patients returned to their daily activities. Our opinion favours conservative approach to fractures involving a dural sinus if the wound is not contaminated as the risk of infection is low. Surgery exposes the patient to the very real risk of massive haemorrhage. In instances where there is a clear need for surgery adequate precautions should be taken. Delayed intracranial hypertension is a possible complication when a depressed skull fracture overlies the saggital sinus and should always be considered in patients with the appropriate clinical findings in the follow-up period