The "Belt and Suspenders" Repair Approach to Intraoperative Sagittal Sinus Injury During Cranial Vault Surgery

This case report detailed a successful surgical repair of a superior sagittal sinus (SSS) injury during a 16-month-old girl's craniosynostosis surgery. The patient presented with symptoms of increased intracranial pressure including irritability, stumbling, and sleep disturbances, stemming from metopic craniosynostosis. During the fronto-orbital advancement procedure, an iatrogenic SSS injury was sustained at the anterior fontanel. The surgical team used an innovative "belt and suspenders" repair technique. This approach involved immediate bleeding control with finger pressure, followed by Gelfoam placement on the injury site. The surrounding pericranium was then sutured over the defect using an imbrication technique. To evenly distribute downward tamponade force, a bone island was created for anchoring tack-up sutures around its periphery. This multilayered approach provided robust repair to control bleeding while maintaining SSS patency. Postoperative computed tomography venogram confirmed no sinus thrombosis, and follow-up visits showed significant improvement in the patient, with resolution of preoperative symptoms. The case highlighted the critical importance of interdisciplinary collaboration in managing rare surgical complications. Although limited as a single-patient report, it provides valuable insight as a potential management strategy for SSS injuries during pediatric craniofacial procedures.