title: Improvement in venous outflow following superior sagittal sinus decompression after a gunshot wound to the head: case report.
abstract: The most commonly described indications for surgical management of closed depressed skull fractures are hematoma evacuation and repair of extensive cosmetic deformity. Venous sinus injury, which occurs in a subset of depressed skull fractures, is not typically listed as an indication for surgical treatment due to the potential for major venous hemorrhage associated with surgery near these structures. However, if patients exhibit signs and symptoms of intracranial hypertension and radiographic findings demonstrate sinus compromise, surgical elevation of the depressed skull fragments is indicated. The authors present the case of a 25-year-old woman with a depressed skull fracture secondary to a gunshot wound with symptomatic compromise in venous outflow of the posterior one-third of the superior sagittal sinus. The patient was treated with surgical decompression via bilateral craniectomy along with intracranial pressure-lowering medical therapy and had almost full resolution of her presenting symptoms with documented improvement in flow through the superior sagittal sinus. While the use of surgical treatment for these types of injuries is highly debated, the authors demonstrate here that safe, effective surgical management of these patients is possible and that surgical decompression should always be considered in the case of symptomatic venous sinus flow obstruction.
authors.affiliation: Departments of 1 Neurosurgery.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Birk
authors.affiliation: Departments of 1 Neurosurgery.
authors.forename: Matthew K
authors.initials: MK
authors.lastname: Tobin
authors.affiliation: Ophthalmology and Visual Sciences, and.|Neurology and Rehabilitation, University of Illinois at Chicago, Illinois.
authors.forename: Heather E
authors.initials: HE
authors.lastname: Moss
authors.affiliation: Ophthalmology and Visual Sciences, and.
authors.forename: Eric
authors.initials: E
authors.lastname: Feinstein
authors.affiliation: Departments of 1 Neurosurgery.
authors.forename: Fady T
authors.initials: FT
authors.lastname: Charbel
authors.affiliation: Departments of 1 Neurosurgery.
authors.forename: Ali
authors.initials: A
authors.lastname: Alaraj
mesh_terms: D000328:Adult; D003392:Cranial Sinuses / Q000000981:diagnostic imaging / Q000293:injuries*; D019299:Decompression, Surgical / Q000379:methods*; D056424:Decompressive Craniectomy / Q000379:methods*; D005260:Female; D020197:Head Injuries, Penetrating / Q000000981:diagnostic imaging / Q000601:surgery*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D019586:Intracranial Hypertension / Q000503:physiopathology / Q000601:surgery; D054063:Superior Sagittal Sinus / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014948:Wounds, Gunshot / Q000601:surgery*
keywords: GSW = gunshot wound; ICP = intracranial pressure; Q-MRA = quantitative MR angiography; Q-MRV = quantitative MR venography; SSS = superior sagittal sinus; craniectomy; gunshot wound; intracranial hypertension; skull fracture; superior sagittal sinus; traumatic brain injury
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