LETTER TO THE EDITOR
Letter to the Editor: Comment on "Gauze Packing and Removal: Two-staged Operations for Hemostasis of Traumatic Sinus Injury"
2026 年 13 巻 p. 329-330
詳細
2026 年 13 巻 p. 329-330
Dear Editor
I have read the study by Nakata et al.1) describing 2 cases of cerebral venous sinus injury (VSI) treated with gauze packing. Gauze packing for VSI is indeed an effective treatment option. The method was first reported in 1901 by Wharton,2) who reported that the most satisfactory and generally available method for treating VSI is bleeding control using aseptic gauze packing. The development of another technique and new materials for venous sinus bleeding has resulted in decreased use of the gauze packing technique. However, gauze packing remains a useful option when more commonly used techniques for venous sinus bleeding are ineffective.
Wharton2) reported that the greatest danger of gauze packing for wounds of the cerebral venous sinuses is septic infection. Antiseptic methods and perioperative antibiotic treatment are important to prevent infection during gauze packing for VSIs. Nakata et al.1) reported that second operations for gauze removal at 4 and 8 days after gauze packing demonstrated no infection of the intracranial portion, although the minimum number of days before intracranial packing removal without the risk of rebleeding was unknown. This is an important issue because delayed removal of gauze packing may result in intracranial infection. Although the exact time for gauze removal has not been established, removal within 1 week after the first operation is recommended.
In the report by Nakata et al.1), the operative indication for Case 1 was unclear. In Figure 1C, multiple skull fractures were identified. As shown in Figures 1A and B, the mass effect did not appear significant. The poor neurological condition of the patient in Case 1 in the emergency department may have resulted from diffuse axonal injury or other causes rather than from the mass effect of the subdural hematoma. Despite removal of the subdural hematoma, the patient demonstrated a Glasgow Outcome Scale score of 3 at follow-up. My recommended treatment for Case 1 is conservative.
My experience with a patient with a sigmoid sinus injury leads me to concur with this recommendation. A 32-year-old male experienced a traffic accident while driving a motorcycle. Computed tomography (CT) performed in the emergency department revealed a right skull base fracture, frontal lobe contusions, intracranial pneumocephalus, and an epidural hematoma. CT of the craniofacial and temporal bones revealed a skull fracture adjacent to the right sigmoid sinus. CT venography revealed severe stenosis of right sigmoid sinus. I considered that conservative treatment for epidural hematoma was the best option when injury to the sigmoid sinus was suspected. Despite an increase in the epidural hematoma and bilateral frontal lobe contusions, the patient recovered well. CT venography performed 11 days after the trauma revealed improvement of stenosis in the right sigmoid sinus. Five months after the accident, the patient demonstrated personality changes due to contusions in both frontal lobes. However, he demonstrated neither weaknesses nor language problems.
In my opinion, skull fractures adjacent to the venous sinus may be associated with VSI. Initial treatment should therefore be conservative and include measures to control the increased intracranial pressure.
This letter to the editor had the approval of the relevant institutional review board (number: NMC-2026-01-005).
All authors have no conflict of interest.
None.
