Management of asymptomatic superior sagittal sinus compression in depressed frontal fracture: A rare case report

Open depressed skull fractures are common injuries and some are emergencies. The incidence of venous sinus involvement in skull fractures is 11.5%. The significance of this type of injury stems from the potential for substantial blood loss during trauma or emergency surgery, which can lead to a high mortality rate in the perioperative period. Depressed fractures located over the venous sinuses can lead to increased intracranial pressure. We report a case of compound depressed frontal fracture with bone fragment compressing the anterior superior sagittal sinus (SSS).

An 18-year-old man presented to the emergency department complained of headaches and vomiting once after falling. The patient was aware and responsive. The vital signs were normal with the Glasgow Coma Scale at 15\15. The computed tomography showed bruising on the right frontal side of the brain and a compressed fracture with bone fragment compressing the anterior SSS but the patient showed no signs of sinus thrombosis or obstruction. Surgical repair and removal of the bone fragment were performed. The patient was discharged after 5 days and followed up for 3 months without recurrence.

Dealing with a depressed skull fracture overlying the SSS presents unique challenges due to the risk of significant vascular injury and potential complications. Managing a depressed skull fracture overlying the SSS requires careful planning, surgical technique, and postoperative care due to its complexity and associated risks. Collaboration with other specialties can enhance outcomes and mitigate risks associated with this challenging scenario.