Vol. 1 ■ Issue 2 ■ July-December 2012 Indian Journal of Neurosurgery 149 Access this article online Quick Response Code: Website: www.ijns.in DOI: 10.4103/2277-9167.102286 CASE REPORT he was referred to a higher center immediately. On arrival to our emergency department, his Glasgow Coma Score (GCS) was 12/15 and pupils were equal and reacting. Local examination showed a stitched wound lying over his skull in the midline at its junction with the coronal suture [Figure 1]. Following resuscitation, emergency CT of the head with 3D reconstruction was done. This demonstrated a subgaleal foreign body (FB), compound depressed skull fracture in the midline, and underlying brain contusion [Figure 2]. From the site of skull and brain injury as seen in the 3D reconstructed view of CT scan, we suspected injury of the middle third of SSS. The patient was shifted to emergency operation theater with two units of whole blood kept ready. On exploration of the wound, a piece of gauge was found in place providing the tamponade effect [Figure 3]. The gauge piece was removed. Exploration of the wound revealed depressed skull fracture with a piece of bone entering into the brain matter [Figure 3]. A circumferential craniectomy was done with wide exposure of the SSS. It was found to be lacerated laterally with surrounding brain contusion. Thorough debridement was done, contused brain evacuated, and the lacerated sinus was suture repaired. Perioperative blood loss of about 200 ml, mostly from the injured sinus, was taken care of by transfusing one unit of blood. Postoperative period was uneventful and he had no neurological deficits, evidence of infection, or symptoms of raised intracranial pressure (suggestive of SSS thrombosis) at the time of discharge. CT scan head with 3D reconstruction at the time of Address for correspondence: Dr. Souvagya Panigrahi, Department of Neurosurgery, S. C. B. Medical College and Hospital, Cuttack, Odisha – 753 007, India. E-mail-souvagya.ms@gmail.com INTRODUCTION Treating traumatic dural sinus injuries puts a high demand on every neurosurgeon. General surgeons are usually afraid of dural sinus injury as a possible complication in the emergency treatment of severe head injury patients. Therefore, knowledge of appropriate treatment of this kind of head injury is essential. Recent development in computed tomography (CT) scan in the form of 3D reconstruction is helpful in this scenario as the preoperative knowledge of the anatomical site is essential for proper planning of surgical management of dural sinus injury. CASE REPORT A 14-year-old boy sustained head injury over the vertex while walking. A piece of asbestos hit his head, penetrated, and caused a compound depressed fracture over the superior sagittal sinus (SSS). He was exsanguinated with blood and became unconscious at the scene of injury. As he was rushed to the nearby primary health center (PHC), the asbestos piece was removed, profuse bleeding was checked by scalp suturing with a piece of gauge in situ, and ABSTRACT Head injuries following fall of heavy objects are not very uncommon in developing countries. However, compound depressed skull fracture with superior sagital sinus (SSS) laceraton caused by a fying asbestos fragment in a stormy afernoon is an unusual mode of head injury. We report such an unusual case of compound depressed skull fracture by an asbestos fragment injuring the middle third of SSS and its successful surgical management in a 14-year-old child. The role of computed tomography (CT) scan of head with 3D reconstructon is highlighted. Early steps taken in this case to check the profuse bleeding, which helped save the life of this boy is interestng to note. Key words: 3D reconstructon, fying asbestos, profuse bleeding, superior sagital sinus laceraton, surgical management Emergency surgical management of traumatic superior sagittal sinus injury: An unusual case Sudhansu Sekhar Mishra, Souvagya Panigrahi, Srikant Das, Sanjay Kumar Behera Department of Neurosurgery, S. C. B. Medical College and Hospital, Cuttack, Odisha, India This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.