Resolution of intracranial hypertension after elevation of depressed cranial fracture over the superior sagittal sinus: case report.
OBJECTIVE
It is common neurosurgical wisdom that depressed cranial fractures (DCFs) over the superior sagittal sinus (SSS) should not be elevated because of the risk of fatal venous hemorrhage.


METHODS
A 34-year-old man presented with severe headache and diplopia after a motor vehicle accident. Clinical examination demonstrated severe papilledema and bilateral abducens palsy. Imaging findings demonstrated a DCF over the posterior third of the SSS and absent flow distal to the fracture with dilated cortical venous drainage.


METHODS
Conservative treatment with acetazolamide only partially alleviated the patient's headache and diplopia. Definitive surgical treatment via elevation of the DCF was discussed and decided upon. Twelve days after injury, the patient underwent midline parieto-occipital craniotomy with successful elevation of the DCF off the posterior third of the SSS. Postoperative magnetic resonance venograms revealed restoration of patency in the SSS with reduced tortuosity of cortical veins. The patient's headache resolved, and his papilledema and diplopia resolved gradually.


CONCLUSIONS
Elevation of DCF over the SSS can be attempted in cases in which favorable bone anatomy and the patient's clinical condition warrant. This may result in rapid and dramatic resolution of signs and symptoms of secondary intracranial hypertension.
Binder
Devin K
DK
Department of Neurological Surgery, University of California at San Francisco, San Francisco, California, USA. dbinder@itsa.ucsf.edu
Sarkissian
Vahé
V
Schmidt
Meic H
MH
Pitts
Lawrence H
LH
D000328:Adult; D003392:Cranial Sinuses / Q000473:pathology*; D006801:Humans; D019586:Intracranial Hypertension / Q000209:etiology*; D008297:Male; D020204:Skull Fracture, Depressed / Q000150:complications*