2016 Volume 39 Issue 1 Pages 41-45
We experienced a case of acute epidural and subdural hematoma associated with superior sagittal sinus injury. Large laceration of the sinus sometimes induces huge bleed-ing with subsequent miserable outcome. The handling of the injured sinus depends on time and situation of the fracture.
An iron plate weighing 200 kg hit the head of 62-year-old man without a helmet. He was referred to our hospital with mild conscious disturbance (JCS: I-3) and right hemparesis. CT images revealed the left acute epidural hematoma, intracranial air, depressed fractures and sagittal suture diastases. His level of consciousness was deteriorated (JCS: II-30) and emergent surgery was performed. First, the craniectomy with the fractured bone on the injured sinus untouched to achieve the decompression of the brain tissue. Next, craniectomy was added to stop bleeding from the injured sinus. Huge bleeding was seen via the torn venous sinus, in spite of the elevated head position. TachoSil® tissue sealing sheet was applied manually to the injured outer wall of the sinus. Then, brain swelling was seen after stopping bleeding from the outer wall of the sinus. Immediately after that, dura was cut with subsequent hemostasis. After complete hemostasis from the injured sinus, dural plasty with fascia was performed. Fortunately the therapeutic course of the patient was excellent. At 3 months after injury, he received cranio-plasty with custom-made titanium mesh. He returned to his daily life without any neurological deficits. In order to obtain good hemostasis from the injured sinus, TachoSil® tissue sealing sheet is effective.
