title: Dural sinus obstruction following head injury: a diagnostic and clinical study.
abstract: OBJECTIVE The aim of this study is to describe the clinical characteristics of patients with skull fracture adjacent to a dural venous sinus (DVS) and evaluate the role of CT venography (CTV) in the diagnosis of the effect of this fracture on the involved DVS. METHODS The study comprised patients with vault or skull base fracture adjacent to a DVS who were admitted to 1 medical center during a 2-year period. The medical records were reviewed for the clinical and radiographic characteristics. All patients had undergone CTV to evaluate potential DVS pathology. The clinical and radiological findings of the patients with DVS pathology were compared with those of the patients with normal DVS. The groups were compared using the chi-square and t-tests for categorical and continuous data, respectively. The potential risk for poor outcome among the patients with DVS pathology was also investigated. RESULTS Of 434 patients with skull fractures, 41 (9.4%) had fractures adjacent to a DVS. DVS pathology was detected in 51% of patients (21 of 41 patients). For 9 (43%) patients, obstruction was extraluminal without thrombosis, and 12 (57%) patients had dural sinus thrombosis (DST). In patients with a positive-CTV scan, the severity of injury according to the Glasgow Coma Scale score at presentation was correlated with the presence of DST (p = 0.007). The sensitivity of noncontrast CT (NCCT) for DVS involvement was 38% among the patients with positive-CTV scans. For patients with DVS pathology, poor outcome was correlated with DST (intraluminal), rather than extraluminal obstruction without thrombosis (p = 0.02), and superior sagittal sinus (SSS) involvement (p = 0.05). CONCLUSIONS NCCT is not sensitive enough to detect DVS obstruction in patients with skull fracture adjacent to a DVS, and CTV should be performed in order to rule it out. A correlation was found between the severity of injury and the presence of DST, rather than extraluminal obstruction. The authors' findings suggest that DST and SSS involvement may be indicators of poor outcome in patients with skull fracture adjacent to DVS.
authors.affiliation: Department of Neurosurgery, Hadassah Medical Center, Jerusalem;
authors.forename: Mony
authors.initials: M
authors.lastname: Benifla
authors.affiliation: Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva; and.|Departments of 3 Internal Medicine.
authors.forename: Uri
authors.initials: U
authors.lastname: Yoel
authors.affiliation: Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva; and.|Neurosurgery, and.
authors.forename: Israel
authors.initials: I
authors.lastname: Melamed
authors.affiliation: Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva; and.|Neurosurgery, and.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Merkin
authors.affiliation: Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva; and.|Neurosurgery, and.
authors.forename: Avi
authors.initials: A
authors.lastname: Cohen
authors.affiliation: Radiology, Soroka University Medical Center, Beer-Sheva, Israel.
authors.forename: Ilan
authors.initials: I
authors.lastname: Shelef
mesh_terms: D000293:Adolescent; D000328:Adult; D002561:Cerebrovascular Disorders / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003287:Contrast Media; D003392:Cranial Sinuses / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007223:Infant; D020767:Intracranial Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010690:Phlebography / Q000379:methods*; D012680:Sensitivity and Specificity; D012887:Skull Fractures / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D003287:Contrast Media
keywords: CTV = CT venography; DST = dural sinus thrombosis; DVS = dural venous sinus; GCS = Glasgow Coma Scale; GOS = Glasgow Outcome Scale; ICP = intracranial pressure; NCCT = noncontrast CT; SSS = superior sagittal sinus; TS = transverse sinus; computed tomography venography; dural sinus thrombosis; head injury; spiral computed tomography; trauma