Compound Depressed Fracture Over Dural Venous Sinuses: Experience of 22 Surgically Treated Cases

Background: Due to high risk of massive blood loss of traumatic injury of dural venous sinus at the time of trauma or emergency operation leading to high mortality rate, we considered the appropriate methods that are most essential in treatment of depressed skull fracture over dural venous sinus to decrease mortality rate as much as possible. Aim of Study: For assessment of surgical interference in cases of depressed skull bone fracture with dural venous sinuses injury is it risky with high mortality rate or can be done safely with different methods or it is better to be conserve than surgical interference. Patients and Methods: Twenty two patients with transsinus compound depressed skull fracture were reviewed retrospectively who presented to emergency department in Aswan university hospitals between January 2014 and June 2018. All patients submitted to computed tomography scan (CT scan) for assessment of fracture site, size and relation to dural venous sinuses. Results: Twenty two patients with a dural venous sinus injury from severe head injuries who had been treated upon in the two hospitals were reviewed retrospectively. There were 18 males and 4 females patients. All cases underwent surgical interference ,with mortality rate (22.73%) of operated cases, due to massive blood loss intraoperative and uncontrolled sinus repair and hypovolemic shock. Conclusion: When there is depressed skull fracture penetrating the sinus, so we will take care for possibility of massive blood loss and uncontrolled repair of injured sinus, and we face a high mortality case. The surgeon should be prepared for the possibility of potentially fatal venous sinus injury, and so, conservative treatment better than surgical intervention of penetrating cases of dural venous sinus injuries as much as possible.