Surgical management of battle gunshot injuries to the dural venous sinuses, combined with brain injury: an analysis of series of observations

Authors

  • H. S. Pylypenko Mechnikov Dnipropetrovsk Regional Clinical Hospital, Dnipro, Ukraine,
  • A. H. Sirko Mechnikov Dnipropetrovsk Regional Clinical Hospital, Dnipro, Ukraine,
  • V. V. Botikov Mechnikov Dnipropetrovsk Regional Clinical Hospital, Dnipro, Ukraine,

DOI:

https://doi.org/10.14739/2310-1210.2020.1.194498

Keywords:

combat head injury, venous sinus injury, superior sagittal sinus

Abstract

 

The present study aimed to summarize the literature data about wounds to the dural venous sinus (DVS) and validating the importance of surgery in a series of clinical observations in patients with craniocerebral gunshot wound (CGW) sustained in battles with the DVS wound.

Materials and methods. We conducted a retrospective analysis of the clinical records and long-term outcomes in patients who were admitted to our medical center from 05/2014 to 12/2017. The study included soldiers with gunshot DVS wounds sustained in battles, who presented with the Glasgow Coma Scale (GCS) score ≥4. Upon admission, damage to the DVS was diagnosed based on spiral computed tomography (SCT) imaging and/or was identified during surgery. All the patients underwent SCT imaging on admission and 12 hours after surgery. When severe damage to the DVS was suspected, cerebral angiography (CAG) was performed. The age, initial GCS score, the Injury Severity Score, location and nature of injuries to the DVS, the location and nature of brain injury, the volume of surgical interventions and the presence of complications in a postoperative period were taken into account. The outcome data included an assessment of the Glasgow Outcome Scale (GOS) in 6 and 12 months.

Results. Of 241 patients with CGW sustained in battles, 21 (8.7 %) presented with wounds to the DVS. The average initial GCS score was 10.0 ± 3.7. Superior sagittal sinus wound was identified in 20 (95.2%) patients and straight sinus wound – in one (4.8 %) patient. Wound to one DVS wall was identified in 15 (68.2 %) cases, wound to two DVS walls – in five (22.7 %) cases, and complete DVS damage (transection) – in two (9.1 %) cases. Twenty (95.2 %) patients presented with DVS wound combined with brain injury: one in the lobe in 10 (47.6 %) patients and ≥2 lobes in 10 (47.6 %) patients. All the patients underwent surgery. CAG was performed in five (23.8 %) patients. DVS ligation was performed in four (19 %) patients.

Five (23.8 %) patients had meningitis, three (14.3 %) patients died. After 6 months, five (23.8 %) patients recovered well (GOS score of 5), 12 (57.1 %) had moderate disability (GOS of 4), and one (4.8%) had severe disability. The significant factors of good outcome within 6 months after the injury were age (P = 0.04) and GCS score on admission (P = 0.01).

Conclusions. The DVS repair via surgery in case of concomitant brain matter injury must be performed very cautiously because of a high risk of developing hemorrhagic complications due to early use of anticoagulants. The feasibility of surgical DVS repair in case of transection can be assessed in large neurosurgical centers for such pathology management to obtain more data.

References

Cushing, H. (1917). A study of a series of wounds involving the brain and its enveloping structures. British Journal of Surgery, 5(20), 558–684. https://doi.org/10.1002/bjs.1800052004

Wallace, P. B., & Meirowsky, A. M. (1960). The Repair of Dural Defects by Graft. Annals of Surgery, 151(2), 174–180. https://doi.org/10.1097/00000658-196002000-00004

Rish, B. L. (1971). The repair of dural venous sinus wounds by autogenous venorrhaphy. Journal of Neurosurgery, 35(4), 392–395. https://doi.org/10.3171/jns.1971.35.4.0392

Meirowsky, A. M. (1953). Wounds of Dural Sinuses. Journal of Neurosurgery, 10(5), 496–514. https://doi.org/10.3171/jns.1953.10.5.0496

Kapp, J. P., & Gielchinsky, I. (1972). Management of combat wounds of the dural venous sinuses. Surgery, 71(6), 913 917.

Holmes, G., & Sargent, P. (1915). Injuries of the superior longitudinal sinus. British Medical Journal, 2(2857), 493–498. https://doi.org/10.1136/bmj.2.2857.493

Nuthall, A. W. (1916). Gunshot wound of the superior longitudinal sinus. A report of three cases. British Medical Journal, 1(2870), 12 14.

Matson, D. D. (1948). The Treatment of Acute Craniocerebral Injuries Due to Missiles. C. C. Thomas, 1948.

Wilson, J.., Pettigrew, L., & Teasdale, G. (1998). Structured Interviews for the Glasgow Outcome Scale and the Extended Glasgow Outcome Scale: Guidelines for Their Use. Journal of Neurotrauma, 15(8), 573–585. https://doi.org/10.1089/neu.1998.15.573

Gazzeri, R., Galarza, M., Fiore, C., Callovini, G., & Alfieri, A. (2015). Use of Tissue-Glue–Coated Collagen Sponge (TachoSil) to Repair Minor Cerebral Dural Venous Sinus Lacerations. Operative Neurosurgery, 11(1), 32–36. https://doi.org/10.1227/neu.0000000000000614

Salunke, P., Sodhi, H., Aggarwal, A., Ahuja, C., Dhandapani, S., Chhabra, R., & Gupta, S. (2013). Is ligation and division of anterior third of superior sagittal sinus really safe? Clinical Neurology and Neurosurgery, 115(10), 1998–2002. https://doi.org/10.1016/j.clineuro.2013.06.003

Sahoo, S., Ghuman, M., Salunke, P., Vyas, S., Bhar, R., & Khandelwal, N. (2016). Evaluation of anterior third of superior sagittal sinus in normal population: Identifying the subgroup with dominant drainage. Journal of Neurosciences in Rural Practice, 7(2), 257–261. https://doi.org/10.4103/0976-3147.176201

Schaller, B., Graf, R., Sanada, Y., Tolnay, M., Rosner, G., Wienhard, K., & Heiss, W. D. (2003). Hemodynamic changes after occlusion of the posterior superior sagittal sinus: an experimental PET study in cats. American Journal of Neuroradiology. 24(9), 1876 1880.

Ryu, C.-W. (2009). Persistent Falcine Sinus: Is It Really Rare? American Journal of Neuroradiology, 31(2), 367–369. https://doi.org/10.3174/ajnr.a1794

Stocker, R. A. (2019). Intensive Care in Traumatic Brain Injury Including Multi-Modal Monitoring and Neuroprotection. Medical Sciences, 7(3), 37. https://doi.org/10.3390/medsci7030037

Sindou M. P., Auque J., & Jouanneau E. (2005). Neurosurgery and the intracranial venous system. In Y. Yonekawa, E. Keller, Y. Sakurai, T. Tsukahara (Eds.), New Trends of Surgery for Stroke and its Perioperative Management (pp. 167-75). Acta Neurochirurgica Supplements, vol. 94. Springer, Vienna. https://doi.org/10.1007/3-211-27911-3_27

Desse, N., Malikov, S., Fuentes, S., Pech-Gourg, G., Graillon, T., & Dufour, H. (2013). Superior sagittal sinus reconstruction using a femoral venous graft after total removal of a meningioma. Case report. Neurochirurgie, 59(1), 43–46. https://doi.org/10.1016/j.neuchi.2012.10.141

Abdel-Aziz, H., Dunham, C., Malik, R. J., & Hileman, B. M. (2015). Timing for deep vein thrombosis chemoprophylaxis in traumatic brain injury: an evidence-based review. Critical Care, 19, 96. https://doi.org/10.1186/s13054-015-0814-z

Levy, A. S., Salottolo, K., Bar-Or, R., Offner, P., Mains, C., Sullivan, M., & Bar-Or, D. (2010). Pharmacologic Thromboprophylaxis Is a Risk Factor for Hemorrhage Progression in a Subset of Patients With Traumatic Brain Injury. The Journal of Trauma: Injury, Infection, and Critical Care, 68(4), 886–894. https://doi.org/10.1097/ta.0b013e3181d27dd5

Weisbrod, A. B., Rodriguez, C., Bell, R., Neal, C., Armonda, R., Dorlac, W., Schreiber, M., & Dunne, J. R. (2012). Long-term outcomes of combat casualties sustaining penetrating traumatic brain injury. Journal of Trauma and Acute Care Surgery, 73(6), 1525–1530. https://doi.org/10.1097/ta.0b013e318270e179

Bell, R. S., Mossop, C. M., Dirks, M. S., Stephens, F. L., Mulligan, L., Ecker, R., Neal, C. J., Kumar, A., Tigno, T., & Armonda, R. A. (2010). Early decompressive craniectomy for severe penetrating and closed head injury during wartime. Neurosurgical Focus, 28(5), Article E1. https://doi.org/10.3171/2010.2.focus1022

Downloads

How to Cite

1.
Pylypenko HS, Sirko AH, Botikov VV. Surgical management of battle gunshot injuries to the dural venous sinuses, combined with brain injury: an analysis of series of observations. Zaporozhye Medical Journal [Internet]. 2020Feb.10 [cited 2024Nov.23];22(1). Available from: http://zmj.zsmu.edu.ua/article/view/194498

Issue

Vol. 22 No. 1 (2020)

Section

Original research

License

Authors who publish with this journal agree to the following terms:

    1. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.  Лицензия Creative Commons
    2. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
    3. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access)