Delayed intracranial hypertension and cerebellar tonsillar necrosis associated with a depressed occipital skull fracture compressing the superior sagittal sinus. Case report.
Depressed skull fractures overlying the major venous sinus are often managed nonoperatively because of the high associated risks of surgery in these locations. In the presence of clinical and radiographic evidence of sinus occlusion, however, surgical therapy may be necessary. The authors present the case of a 9-year-old boy with a depressed skull fracture overlying the posterior third of the superior sagittal sinus. After initial conservative treatment, delayed signs of intracranial hypertension and a symptomatic tonsillar herniation with tonsillar necrosis developed. Possible causes as well as diagnostic and treatment options are reviewed.
Vender
John R
JR
Department of Neurosurgery, Medical College of Georgia, Augusta, Georgia 30912, USA. jvender@mail.mcg.edu
Bierbrauer
Karin
K
D002531:Cerebellum / Q000473:pathology*; D002648:Child; D003392:Cranial Sinuses / Q000473:pathology; D006801:Humans; D019586:Intracranial Hypertension / Q000209:etiology; D008297:Male; D009336:Necrosis; D009777:Occipital Bone / Q000293:injuries*; D020204:Skull Fracture, Depressed / Q000150:complications* / Q000601:surgery*; D013997:Time Factors