Penetrating Superior Sagittal Sinus Post Part Injuries by Carpenter’s Nail

Abstract

Introduction. Superior sagittal sinus posterior part injuries can rapidly lead to death by uncontrollable bleeding.The type of weapon used, the size of the sinus wound and the portion of the sinus concerned can make their gravities. We report diagnostic circumstances, treatment and evolution of 3 cases of penetrating superior sagittal sinus injuries by carpenter's nail. Methods. We describe 3 cases of a penetrating superior sagittal sinus posterior part injuries by carpenter's nail admitted in Neurosurgery department of Yalgado Ouédraogo University Teaching Hospital of Ouagadougou in 2007, 2013 and 2017. Results. Three patients aged 25, 28 and 24 years respectively admitted 19 hours on average after a traumatic brain injury by a penetrating object. Circumstance was the popular verdict 1 case. In the other cases, the circumstance could not be elucidated. The neurological examination was normal for the 3 patients. Local examination noted in 2 patients, a nail implanted in the skull in the posterior part of the median line. In 1 patient, there were 2 punctiforms wounds of the scalp in the posterior part of the median line. CT scan showed a large nail about 10 cm long in 2 patients and 2 nails of the same size in 1 patient. These nails were in contact or crossing the superior sagittal sinus in its posterior part. The removal of these nails was done under general anesthesia. The postoperative course was simple under antibiotic prophylaxis. Conclusion. Posterior sagittal sinus injuries by carpenter's nails were criminal origin in a context of popular justice. During their ablation under general anesthesia, bleeding from the superior sagittal sinus caused by nails removal was controlled by finger compression and stopped by placement of hemostatic compresses. Apposition of epicranium reinforced the dura closure.