Surgical Elevation for Symptomatic Depressed Skull Fractures Over Dural Venous Sinus

Abstract
Background: Symptomatic depressed skull fractures over dural venous sinus occasionally lead to stenosis, obstruction, or thrombosis and resulting in intracranial hypertension and significant neurological deficit. Some neurosurgeons are treating these cases conservatively for fear of venous hemor-rhage. The surgical elevation of the depressed segment in these cases is a matter of controversy and these patients should be treated carefully.
Aim of Study: The aim of this retrospective study was to evaluate outcome after surgical elevation of symptomatic depressed skull bone fracture over dural venous sinus.
Patients and Methods: A retrospective study of sympto-matic depressed calvarial fractures presented at Mansoura University Hospital from 2015 to 2018 revealed 11 patients with depressed skull fractures over superior sagittal sinus (n=6) and transverse sinus (n=5). The age ranged from 11-31 years. The causes of these fractures were vehicle accidents and falling from height. Significant neurological deterioration ranged from blurring of vision and motor weakness. MR venography was done in stable and late symptomatic cases to assess sinus patency.
Results: Surgical elevation was performed in 10 patients suffered from depressed skull fracture over large venous sinus and conservative treatment for one patient at the transverse sinus and the patient shows patent sinus on MRV and clinically well. Rapid resolution of symptoms and signs as well as sinus patency after elevation.
Conclusion: Although the risk of sinus injury during surgical elevation of the depressed segment but it is recom-mended to perform surgery for these symptomatic patients with all precautions required like blood transfusion and preparing vascular graft form the pericranium for sinus repair and this leads to rapid resolution of symptoms and signs as well as sinus patency improvement after elevation.