Nepal Journal of Neuroscience
Official Journal of Nepalese Society of Neurosurgeons

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Depressed Skull Fracture Over Superior Sagittal Sinus: Is the Elevtion Rightly Cotraindicated?

Dr. Amit Thapa, MS, MCh
National Institute of Neurological and Allied Sciences (NINAS) Bansbari, Kathmandu, Nepal

The classical teaching in depressed skull fracture is to treat conservativelythose which lie over superior sagittal sinus. This may be true in view of expected blood loss and skills required to handle the sinus bleed. However conservative approach in such case exposes the patient to the risk of cerebral venous thrombosis and consequent venous infarct. We report here a case of a 27 year male who met with an accident. He had depressed parietal bone fracture over superior sagittal sinus. Initially he was managed conservatively; however on 10th day of his injury, he started developing spastic paraparesis with gradual involvement of upper limb with deteriorating consciousness level. Computerized tomography scan showed depressed parietal bone fracture with development of bilateral venous infarct over parietal lobe. He was immediately explored and fracture segment elevated. Post operatively, his weakness and consciousness level gradually improved. The recent literature has started questioning this long held belief of conservative care. If expertise of tackling the sinus bleed is available, one must elevate the depressed skull fracture in previously considered no manís land.

Key Words: Cortical venous thrombosis, Depressed skull fracture, Superior Sagittal Sinus, venousInfarction