- Department of Neurosurgery, Christian Medical College, Ludhiana – 141 008, Punjab, India
- LTMG Hospital and LTMG Medical College, Sion (West), Mumbai – 400 022, Maharashtra, India
Jacob Eapen Mathew
LTMG Hospital and LTMG Medical College, Sion (West), Mumbai – 400 022, Maharashtra, India
DOI:10.4103/2152-7806.69379© 2010 Mathew JE This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
How to cite this article: Mathew JE, Sharma A. Bizarre depressed skull fracture by a tile fragment in a young child, causing superior sagittal sinus injury. Surg Neurol Int 16-Sep-2010;1:52
How to cite this URL: Mathew JE, Sharma A. Bizarre depressed skull fracture by a tile fragment in a young child, causing superior sagittal sinus injury. Surg Neurol Int 16-Sep-2010;1:52. Available from: http://sni.wpengine.com/surgicalint_articles/bizarre-depressed-skull-fracture-by-a-tile-fragment-in-a-young-child-causing-superior-sagittal-sinus-injury/
Background:Head injuries following fall from height are not very uncommon in developing countries due to a lack of safety standards. We describe this bizarre injury by a tile fragment penetrating the superior sagittal sinus (SSS) and its successful surgical management.
Case Description:A 7-year-old child presented with a tile fragment embedded in the skull, penetrating SSS. Urgent exploration and removal of the foreign body was done to prevent complications like infection and delayed development of intracranial hypertension. Although bleeding from the SSS was a problem, this was tackled by raising the head end and giving pressure with Surgicel and Gelatine sponge. This ensured a favorable outcome.
Conclusion:Although compound depressed fractures of the SSS are managed conservatively due to the risk of fatal venous hemorrhage, the unique nature of the injury in this case warranted surgical management. This case illustrates that even in such a scenario, adherence to neurosurgical principles can ensure a good outcome.
Keywords: Depressed skull fracture, tile fragment, superior sagittal sinus
Head injuries following fall from height is not very uncommon in developing countries due to a lack of safety standards. A variety of foreign bodies penetrating the cranium has been described in the literature and it often requires operative intervention. However the management of compound depressed fractures of the superior sagittal sinus (SSS) is generally non operative in view of the inherent surgical risks. We describe this bizarre injury by a tile fragment causing a depressed skull fracture over the SSS and its successful surgical management.
A 7-year-old child presented with a history of fall from a height of 10 feet from the roof of his house, 2 hours prior to presentation. He had a history of transient loss of consciousness. On examination, vitals signs were stable, Glasgow Coma Score (GCS) score was 15/15 and pupils were equal and reacting. There was no evidence of systemic injury. Local examination showed that a piece of tile fragment had penetrated the skull in the midline just anterior to the coronal suture [Figures
Lateral skull X-rays and computed tomography (CT) of the head revealed that the foreign body (FB) had penetrated 1.5 cm deep to the inner table through a fracture of the skull in the midline [Figures
Depressed skull fractures involving the SSS are generally treated conservatively as attempts at surgical elevation can cause fatal venous hemorrhage.[
Surgery might also be warranted in rare instances of delayed intracranial hypertension in such depressed fractures overlying the SSS, as reported by Fuentes et al.[
A few additional points merit mention here. The sagittal sinus can be safely transected in its anterior one third, should this become necessary. The sagittal sinus can be repaired in its middle and posterior one third. A bone island surrounding the FB can be created with the help of a high speed drill and the SSS can be mobilized distally and proximally. This can be followed by a direct repair of the SSS. It is also possible to resect the SSS and replace it with a vein or dural graft although it is technically very demanding.[
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