Traumatic Cranial Dural Venous Sinus Injury

Abstract

Purpose: The study's objective is to elucidate and discuss the causes of traumatic dural venous sinus injury and make comparisons between these causes. The aim is also to assess the susceptibility of dural sinuses to injury in descending orders. Additionally, the research examines the relationship between types of fracture and the challenges in controlling bleeding in patients with traumatic dural venous sinus injury. Furthermore, the study analyzes the factors that influence the morbidity and mortality rate among patients with traumatic dural venous sinus injury.

Methodology: Between January 2021 and October 2022, a prospective study was carried out, involving 22 patients diagnosed with dural venous sinus injury. The study encompassed both surgically and conservatively treated patients. For each participant, demographic information, such as age, sex, causative trauma, preoperative GCS, preoperative deficit, image findings, name, and part of the injured sinus, as well as the presence and absence of a fracture and its relation to the sinus were recorded. The intraoperative method employed to control bleeding and the amount of blood transfusion were also documented, along with postoperative GCS and postoperative complications. The Glasgow Coma Scale (GCS) score was utilized to assess the neurological outcome.

Findings: The most frequently injured dural venous sinus was the superior sagittal sinus, accounting for 77.3% of cases. Among patients with a linear skull fracture crossing the venous sinus, 83.3% had bleeding that could be easily controlled by placing Gelfoam over the injured sinus . However, in patients with a skull fracture parallel to the sinus over the venous sinus and those with depressed fractures (with/without penetration), we encountered greater difficulty in controlling bleeding. Only 16.7% and 10% of these cases, respectively, were easily controlled by placing Gelfoam over the injured sinus, necessitating additional techniques to control bleeding in the remaining patients. Out of the total patients, 20 were managed surgically, while two were managed conservatively due to a Glasgow Coma Scale (GCS) score of 3 and signs of brain death.

Unique Contributions to Theory, Policy and Practice: The superior sagittal sinus was identified as the most commonly injured sinus. Road traffic accidents (RTAs) accounted for the most frequent cause of dural sinus injury, representing 40.9% of cases. Bleeding control proved more challenging when dealing with linear fractures parallel to the sinus or depressed (and/or penetrating) fractures over the sinus, compared to linear fractures crossing the sinus. The most significant factor influencing the mortality rate was the Glasgow Coma Scale (GCS) score on admission. Mortality and morbidity rates were highest in cases involving injury to the posterior part of the superior sagittal sinus, sigmoid sinuses, and combined injury to the anterior and middle parts of the superior sagittal sinus. Furthermore, the mortality rate was notably higher among military-injured patients than civilian-injured patients