Rupture of the Superior Sagittal Sinus in Penetrating Head Injury—Management of a Rare Trauma Mechanism

Abstract

Civilian penetrating head injury caused by foreign objects is rare in Germany (Europe), but can result in complex neurovascular damage. We report on a patient who in suicidal intent inflicted on himself a penetrating brain injury near the vertex with a captive bolt gun. A laceration at the junction of the middle to the posterior third of the superior sinus occurred by bolt and bone fragments leading to critical stenosis and subsequent thrombosis. Upon surgery, the proximal and distal sinus openings were completely thrombosed. The sinus laceration was closed by suture and the intraparenchymal bone fragments were retrieved. Postoperative angiography disclosed persistent occlusion of the superior sagittal sinus. The patient did not develop any symptoms due to venous congestion (edema, hemorrhage), suggesting sufficient collateral venous outflow. The patient completely recovered despite the complexity of the lesion.

Captive Bolt Gun-Related Vascular Injury: A Single Center Experience

“…In our series, only one out of seven surgically treated cases involved craniectomy. Described are cases with either craniotomy or craniectomy with mixed results [2,[4][5][6][7]. We consistently employed galea reconstruction and sinus cranialization to separate cranial spaces in cases of paranasal sinus communication, mitigating cerebrospinal fluid-related ascending infections.…”

“…Captive bolt gun (CBG) head injuries represent a rare form of penetrating brain injuries with only a few documented cases in the literature [1][2][3][4][5][6][7]. This is a device that is commonly employed in the meat industry to stun animals before slaughter [1,2].…”

“…The anatomic distribution of vascular territories can be radiologically assesed despite anatomical variations in the vascular tree [8,9]. There are three known radiological factors of a poor outcome in penetrating head injury: trajectory crossing midline, hematocephalus, and vascular injury [2,7].…”