Simple depressed skull fracture causing sagittal sinus stenosis and increased intracranial pressure: case report and review of the literature

The surgical management of depressed skull fractures is determined in part by whether a fracture is open or closed. Open fractures are usually elevated surgically, but closed fractures are most often treated nonoperatively, and the only 2 indications commonly described for operative treatment of closed fractures are hematoma evacuation and correction of cosmetic deformity. There is another indication, however, that is occasionally encountered when a depressed skull fracture injures a venous sinus. This injury can result in venous sinus stenosis, leading to venous hypertension and elevated intracranial pressure (ICP). A case is presented of closed depressed fracture of the midline skull, causing compressive stenosis of the superior sagittal sinus (SSS), venous hypertension, and encephalopathy. The fracture was surgically elevated to relieve the compression of the SSS and the encephalopathy resolved. The clinical identification, the imaging, and the risks and benefits of operative repair of this condition are reviewed. Increased ICP secondary to venous sinus injury is not commonly described in association with closed depressed skull fractures, but should always be considered in patients with the appropriate clinical findings when a fracture overlies a venous sinus, even in the absence of a hematoma.