0:01

One of the complications of temporal bone

0:04

fractures or occipital bone fractures,

0:06

is injury to the transverse or sigmoid sinus.

0:10

Here we have images from a CT venogram.

0:14

And what you can see is this large collection of blood.

0:18

It's actually not contrast, contrast is much more dense.

0:21

And this is seen in the epidural space associated with

0:25

a comminuted fracture of the occipital bone.

0:28

So here's the comminuted fracture of the occipital bone.

0:31

You have a little bit of air collecting there.

0:33

But what we see on these soft tissue windows is the disruption

0:37

of the transverse sinus with hemorrhage collecting.

0:41

And this hemorrhage, as you can see,

0:42

crosses from the posterior fossa down here with the

0:45

cerebellum and extends into the supratentorial space, across

0:51

the occipital lobe. So if it's going across the tentorium,

0:57

it must be in the epidural space.

0:59

And this can be better demonstrated

1:01

potentially on a sagittal scan,

1:04

where you can see that the collection has

1:06

effectively tracked deep to the torcula,

1:11

which is the confluence of the venous sinuses and goes from

1:15

the posterior fossa into the supratentorial space,

1:19

and displaces the sagittal sinus anteriorly.

1:22

So by virtue of that location, it can't be a subdural location.

1:27

It must be an epidural location.

1:29

When we look at this from the standpoint of the temporal bone,

1:32

we see that on the left side,

1:35

there's a little bit of fluid in the mastoid air cells.

1:38

And as we go further inferiorly,

1:40

we notice that there's some air just adjacent

1:43

to the posterior mastoid air cells here.

1:46

And that likely means that there's a fracture with

1:49

communication into the soft tissue

1:51

at the inferior mastoid tip region.

1:54

And you can see that also in the stylomastoid foramen

1:58

with a small amount of air. On the right side,

2:01

the temporal bone didn't look as bad.

2:03

Just a little bit of fluid communicating

2:05

in the middle ear cavity.

2:08

However, more superiorly,

2:09

we did see a fracture that was involving the superior portion

2:14

of the temporal bone communicating intracranially.

2:17

Remember that communication of these temporal bone fractures

2:21

with the intracranial compartment, renders the patient

2:25

at high risk for CSF leakage and potentially

2:29

intracranial hypotension,

2:31

as well as the complications of meningitis

2:34

and/or a subdural or epidural empyema.

Case 9 - Transverse Sinus Injury

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