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Dural Venous Sinus Injury

Last Updated: March 27, 2020

A significant transverse sinus injury occurred during the craniotomy for resection of a right occipital glioma. Details of hemostasis and reconstruction will be discussed in the following chapter.

Several neurosurgical approaches expose or manipulate the dural venous sinuses. The skilled surgeon should master the venous anatomy through a detailed study of the preoperative images, expect intraoperative difficulty and prepare appropriately. Compared to the cerebral arteries, the veins and dural sinuses do not get the attention they deserve.

Despite the use of meticulous microsurgical techniques, dural venous sinus injury and bleeding is encountered by virtually all neurosurgeons. Dural sinus injury and occlusion can lead to devastating venous infarction and irreversible neurologic deficits, if not handled judiciously. Therefore, it is imperative to anticipate, be prepared, remain calm, and be determined to manage dural sinus bleeding wisely.

Some measures are worth special emphasis. As a preventive measure, unnecessary exposure of the venous sinuses should be avoided and craniotomies should be no closer than 1.5 cm to midline...