title: Management of superior sagittal sinus injury encountered in traumatic head injury patients: Analysis of 15 cases.
abstract: BACKGROUND
  Significant dural sinus injury occurs in 1.5- 5% of all head injuries and injury to superior sagittal sinus accounts for 70-80% of these. Its management is also a challenging issue to every neurosurgeon.
  
  
  METHODS
  In a period of one year (Aug 2011 to july2012) out of 549 cases of head injuries operated in our department analysis of 15 cases (2.73%) shown to have superior sagittal sinus injury. Three dimensional reconstruction of skull bone during CT scan helped us to diagnose possible dural sinus injury pre-operatively.
  
  
  RESULTS
  SSS injury was due to direct impact of fracture segment (5 cases), extension of fracture line over sinus area (4 cases) or due to coronal suture diastases (6 cases). Injury to anterior third of sagittal sinus occurred in 12 cases (80%) and injury to middle third occurred in 3 cases (20%). Small tear over superior sagittal sinus was found in 7 cases (46.66%) and was managed with Gelfoam(®) compression only and in two cases (13.33%) were large tear, which was managed with sinoraphy. In four cases (36.34%) hitch stitches over Gelfoam(®) to adjacent bone given and in rest two cases (13.33%) a strip of bone was left over the sinus area and bilateral hitch stitches were applied.
  
  
  CONCLUSIONS
  Injury to SSS in traumatic head injury patient though rarely encountered during surgery, the management is challenging to every neurosurgeon. Preoperative suspicion and combination of surgical techniques rather than one single technique may be effective in decreasing the sinus related mortality rate.
authors.affiliation: Department of Neurosurgery, S.C.B. Medical College and Hospital, Cuttack, Odisha, India.
authors.forename: Sanjay K
authors.initials: SK
authors.lastname: Behera
authors.affiliation: Department of Neurosurgery, S.C.B. Medical College and Hospital, Cuttack, Odisha, India.
authors.forename: Satya Bhusan
authors.initials: SB
authors.lastname: Senapati
authors.affiliation: Department of Neurosurgery, S.C.B. Medical College and Hospital, Cuttack, Odisha, India.
authors.forename: Sudhansu Sekhar
authors.initials: SS
authors.lastname: Mishra
authors.affiliation: Department of Neurosurgery, S.C.B. Medical College and Hospital, Cuttack, Odisha, India.
authors.forename: Srikant
authors.initials: S
authors.lastname: Das
keywords: Depressed fracture; dural sinus injury; superior sagittal sinus injury