Andi Nugraha Sendjaja*, Agung Budi Sutiono, Ahmad Faried and Muhammad Zafrullah Arifin
Department of Neurosurgery, Hasan Sadikin Hospital – Padjadjaran University Faculty of Medicine, Bandung Indonesia
Received: 09 December, 2015; Accepted: 02 January, 2016; Published: 07 January, 2016
Andi Nugraha Sendjaja, MD, Department of Neurosurgery, Hasan Sadikin Hospital, Padjadjaran University Faculty of Medicine, Jl Pasteur 38 Bandung Indonesia, Tel/Fax: 62-22-2041694; E-mail :
Sendjaja AN, Sutiono AB, Faried A, Arifin MZ (2016) Open Depressed and Compound Elevated Skull Fracture over the Superior Sagittal Sinus: A Case Report. J Surg Surgical Res 2(1): 001-004.10.17352/2455-2968.000020
© 2015 Sendjaja AN et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Open depressed; Compound elevated; Skull fracture; Superior sagittal sinus
This is a case report of an open depressed and compound elevated skull fracture that located in the area where superior sagittal sinus lies beneath. This is a very rare variant of skull fractures. This patient was admitted to our Department of Neurosurgery Hasan Sadikin Hospital, Bandung Indonesia. He is a 14 years old male with motor vehicle accident and diagnosed with compound elevated and depressed skull fracture. A CT Scan demonstrated an Epidural hematoma with suggested cerebral prolapse. The initial GCS was 15 with slight hemiparesis and the patient underwent an emergency surgery. The elevated skull compound was fixated by a titanium mesh but we left the prolapse untouched, then the procedure followed by duraplasty using a pericranial flap. After 7 days of post-op treatment he was discharged without any neurological deficit. With proper emergency surgery, and by preserving the prolapsed brain tissue with fixation on the elevated skull fracture to prevent further injury may give a good results on this patient.
Skull fractures are classified into linear, depressed and comminuted . A depressed fracture is one wherein the fractured fragment driven inwards. On the other hand, in elevated fracture, the fractured portion is elevated above the level of the intact skull . Compound elevated fractures are caused by tangential injuries which slice off a portion of the scalp, skull and the underlying Dura and brain. They are frequently due to assaults with sharp edged weapons . The principle of management is identical to those of compound depressed fractures with the elevated bone fragments being replaced into position after proper closure of the Dura. Delay or failure to operate these may result in meningitis or formation of abscess .
A fourteen years old boy suffered a blunt force trauma onto the top of his head, caused by motor vehicle accident. Skull X-Ray performed 3 hours after accident, showed depressed skull fracture more than 1 table located mid-parietal with adjacent linear fracture (Figures 1, 2). The patient was fully conscious with Glasgow Coma Scale scored 15, a lacerated wound located at mid parietal sized 6x3 cm based on bone fracture (Figure 5), there was no history of unconscious, vomiting, and bleeding from ear, mouth, nose after accident although a slight hemiparesis was detected. An emergency hemorrhage-control scalp stiches was done in nearby emergency facilities. We performed head CT-Scan and found a depressed skull fractured at mid parietal with an epidural hematoma located ontop of Superior Sagittal Sinus, a 3D skull reconstruction was performed to get a more detailed information about the fracture (Figures 2, 3, 4).