David LeFeuvre1, Allan Taylor, Jonathan C Peter. 1. Department of Neurosurgery, H53 Old Main Building, Groote Schuur Hospital, Observatory 7925, Cape Town, South Africa.
Abstract
BACKGROUND: Neurosurgeons have always been wary about operating on compound depressed skull fractures overlying a venous sinus. Conservative treatment of such lesions, however, must be weighed against the benefits of surgery reducing sepsis, mass effect, and improving cosmetic appearance. There has been little published on this surgical problem and with this in mind, we undertook a review of the clinical features, management and outcome of patients presenting to our unit with a depressed fracture over a venous sinus. METHODS: A retrospective review of all patients presenting with a compound depressed skull fracture over a venous sinus from 1997 to 2000. Computer tomography scans and patient records were used. RESULTS: Of the 146 patients with depressed skull fractures, 27 (18%) were eligible. Of the 27 patients, 14 were treated conservatively and 13 were treated with surgery. Intra-operative difficulty was experienced in 6 (46%) of those taken to the operating room. Of those treated conservatively 14% developed sepsis. CONCLUSION: We feel that a more conservative approach to fractures involving a sinus is warranted. If the wound is not contaminated, the risk of infection is low. Surgery exposes the patient to the very real risk of massive hemorrhage. In instances where there is a clear need for surgery, such as the presence of mass effect or deep contamination, adequate precautions should be taken.
BACKGROUND: Neurosurgeons have always been wary about operating on compound depressed skull fractures overlying a venous sinus. Conservative treatment of such lesions, however, must be weighed against the benefits of surgery reducing sepsis, mass effect, and improving cosmetic appearance. There has been little published on this surgical problem and with this in mind, we undertook a review of the clinical features, management and outcome of patients presenting to our unit with a depressed fracture over a venous sinus. METHODS: A retrospective review of all patients presenting with a compound depressed skull fracture over a venous sinus from 1997 to 2000. Computer tomography scans and patient records were used. RESULTS: Of the 146 patients with depressed skull fractures, 27 (18%) were eligible. Of the 27 patients, 14 were treated conservatively and 13 were treated with surgery. Intra-operative difficulty was experienced in 6 (46%) of those taken to the operating room. Of those treated conservatively 14% developed sepsis. CONCLUSION: We feel that a more conservative approach to fractures involving a sinus is warranted. If the wound is not contaminated, the risk of infection is low. Surgery exposes the patient to the very real risk of massive hemorrhage. In instances where there is a clear need for surgery, such as the presence of mass effect or deep contamination, adequate precautions should be taken.
Authors: Daniel M Birk; Matthew K Tobin; Heather E Moss; Eric Feinstein; Fady T Charbel; Ali Alaraj Journal: J Neurosurg Date: 2015-04-03 Impact factor: 5.115