Intracranial hypertension caused by a depressed skull fracture resulting in superior sagittal sinus thrombosis in a pediatric patient: treatment with ventriculoperitoneal shunt insertion
| Autor: | Jonathan A. Forbes, Adam S. Reig, Luke Tomycz, Noel Tulipan |
|---|---|
| Rok vydání: | 2010 |
| Předmět: |
Male
medicine.medical_specialty Administration Oral Sagittal Sinus Thrombosis Ventriculoperitoneal Shunt Parietal Bone medicine Humans Off-Road Motor Vehicles Enoxaparin Child Infusions Intravenous Neuronavigation Skull Fracture Depressed medicine.diagnostic_test Heparin Lumbar puncture Vascular disease business.industry Anticoagulants General Medicine medicine.disease Thrombosis Cerebral Angiography Surgery SSS Occipital Bone Angiography Intracranial Hypertension Headaches medicine.symptom Superior Sagittal Sinus Tomography X-Ray Computed business Follow-Up Studies Superior sagittal sinus |
| Zdroj: | Journal of Neurosurgery: Pediatrics. 6:23-28 |
| ISSN: | 1933-0715 1933-0707 |
| DOI: | 10.3171/2010.3.peds09441 |
| Popis: | Object Intracranial hypertension resulting from compression of the superior sagittal sinus (SSS) by an overlying depressed calvarial fracture is a rare condition. Primary surgical treatment for the symptomatic patient in this setting traditionally involves elevation of the fracture, which often carries significant associated morbidity. Methods The authors report a case involving a 6-year-old boy who suffered a closed, depressed, parietooccipital fracture as the result of an unhelmeted all-terrain vehicle accident. This fracture caused compression and subsequent thrombosis of the SSS, which resulted in CSF malabsorption and progressive intracranial hypertension. Initially headache free following the injury, he had developed severe and unremitting headaches by postinjury Day 7. A CT angiography study of the head obtained at this time exhibited thrombosis of the SSS underlying the depressed calvarial fracture. Subsequent lumbar puncture demonstrated markedly elevated intrathecal pressures. Large volumes of CSF were removed, with temporary improvement in symptoms. After medical management with anticoagulation failed, the decision was made to proceed with image-guided ventriculoperitoneal shunt insertion. Results The patient's headaches resolved immediately following the procedure, and anticoagulation therapy was reinstituted. Follow-up images obtained 4 months after the injury demonstrated evidence of resolution of the depressed fracture, with recanalization of the SSS. The anticoagulation therapy was then discontinued. To the authors' knowledge, this report is the first description of ventriculoperitoneal shunt insertion as the primary treatment of this infrequent condition. Conclusions This report demonstrates that select patients with this presentation can undergo CSF diversion in lieu of elevation of the depressed skull fracture—a surgical procedure shown to be associated with increased risks when the depressed fracture overlies the posterior SSS. The literature on this topic is reviewed and management of this condition is discussed. |
| Databáze: | OpenAIRE |
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