Depressed Skull Fractures Overlying Dural Venous Sinuses: Management Modalities and Review of Literature

Özet

AIM: To characterize the sociodemographic, clinical and radiological findings of patients with depressed skull fractures overlyingcranial dural sinuses that we have faced in our institute. In addition, to explore the indications and choices for the surgical and nonsurgical management of such cases, and assess outcomes in these two treatment groups.MATERIAL and METHODS: We prospectively followed up a cohort of 34 patients with fractures over dural venous sinusesfrom January 2013 to December 2017. Twelve (35.1%) were simple depressed fractures (SDFs) and 22 (64.7%) were compounddepressed fractures (CDFs). Eighteen patients (52.9%) were treated surgically, and 16 (47.1%) were treated conservatively.RESULTS: The mean age was 20.8 years. Thirty-two of the patients were males (94.12%). The mean time from trauma until hospitalarrival was 3.8 hours, and the mean admission Glasgow Coma Score (GCS) was 13.7. Direct trauma was the most common modeof injury. Funduscopy was performed in 16 patients (47.1%), and magnetic resonance venography (MRV) in four patients (11.8%).Twenty-four patients (70.59%) had the fracture overlying the superior sagittal sinus (SSS). The mean length of hospital stay was fivedays, and the mean follow-up duration was 6.8 months. Twenty-eight patients (82.35%) had a good recovery.CONCLUSION: The majority of SDFs and some CDFs overlying dural sinuses can be managed safely without major surgicalintervention. Conservation should be favored when the sinus is patent, dura intact, and bone displacement is insignificant inneurologically intact patients with an apparently clean wound. Otherwise, surgery should be considered. We also propose includinga funduscopic examination and venogram as parts of the initial trauma work-up for these patients.