No abstract

Background Depressed skull fracture overlying venous sinuses deserves a special attention among skull fractures. It puts high demand on every neurosurgeon, as the management of this kind of trauma carry high risk of mortality. It is considered as one of the most dangerous complications of head injuries. Either it is due to fatal venous bleeding, or disturbing the intracranial pressure via thrombosis or stenosis. Therefore, knowledge of appropriate treatment of this kind of head injury is essential. Moreover, it should always be treated with high cautions. Aim of the Work This study aims at reviewing available scientific data based on clinical trials about the proper management approaches for the treatment of depressed skull fractures overlying major cranial venous sinuses. Either through surgery or medical and conservative management. Patients and Methods The study review yielded 22 relevant papers, with a total number of 85 patients. These patients presented to different institutes, at the period between 1996 and 2017. Diagnosed with depressed skull fracture overlying major venous sinuses. The cases divided according to the way of management as follow: 72% of patients treated with surgical approaches. While 28% of patients treated with conservative care. Results In total surgical intervention showed to be successful in 53 patients, out of 85 patients included in the study, without any intraoperative complication of bleeding. While 6 patients passed away during the surgical interventions. On the other hand, 18 patients who treated conservatively did not need any further intervention. While 2 studies reported the need of medication following surgery. Furthermore, 6 studies reported failure of conservative management, and needed urgent surgical elevation of the depressed fragment that compressing the sinus. Based on the results, the mortality rate over all was 7%; death was mainly due to inability to control the profusely bleeding from the injured sinuses. With a success rate over the surgical cases in 87%. While it was 75% over the conservative cases. However, this pooled data need further statistical analysis to obtain guiding evidence for current practice. Conclusions Clinical decision making must be tailored to each patient independently. In the presence of clinical and radiographic evidence of sinus occlusion surgery is preferred. In such instances where there is a clear need for surgery, adequate precautions should be taken, and an expertise in neurotrauma should always be available. Delayed intracranial hypertension is a possible complication and should always be considered in all patients.

Background Traumatic thoracic and lumbar fractures are very common specially in the thoracolumbar junction and the most common causes are road traffic accidents and falling from height. Aim of the Work to evaluate efficacy of ligamentotaxis in thoracic and lumbar compressed and burst spine fractures using intact posterior longitudinal ligament and factors affect its outcome without anterior vertebral decompression through repositioning retropulsed segments, restoring vertebral height. Patients and Methods This study was conducted on 20 patients (with Non-propability convenience sample) with traumatic thoracic and lumbar spine fractures with intact posterior longitudinal ligament in El-maadi military hospital, Ain Shams university hospital during the period of 2017-2018. Results The most common postoperative complication was infection in 5 % of patients and CSF leakage infection in 5 % of patients. Conclusion The outcome in the study were successful in 95% of patients as reduction of retropulsed part occurred by the intact posterior longitudinal ligament.