Management of Sigmoid Sinus Injury: Retrospective Study of 450 Consecutive Surgeries in the Cerebellopontine Angle and Intrapetrous Region

Abstract

Abstract BACKGROUND The sigmoid sinus is the biggest obstacle when approaching the posterior fossa and temporal bone. Adequate sinus exposure is required to obtain a sufficient operative field, but sinus injury is a potentially life-threatening complication. OBJECTIVE To present our experience of sigmoid sinus injury and its management during surgeries in the cerebellopontine angle and intrapetrous region, with operative videos. METHODS A total of 450 consecutive surgeries (385 retrosigmoid and 65 transmastoid approaches) over a 4-yr period were retrospectively investigated, focusing on sigmoid sinus injury, its repair technique, and long-term patency of the sinus. RESULTS Pinhole-sized bleedings were controlled sufficiently by bipolar coagulation or fibrin glue-soaked hemostatic fabric. For lacerations of smaller than 3 mm, the sinus wall was reconstructed by suturing. For larger or unsuturable holes, patching a Gore-Tex membrane on a fibrin glue sheet (without any suturing) was used for the reconstruction. Hemostatic agents were not used for large lacerations to avoid any potential risks of delayed sinus occlusion. Major sinus injury requiring suturing or Gore-Tex patching occurred in 13 cases (2.9%). The bleeding was immediately controlled without sinus clamping, and surgery was not discontinued owing to the injury in any of them. The patients had no postoperative symptoms associated with sinus injury. In all the reconstructed sinuses, patency was confirmed on magnetic resonance imaging at the final follow-up. CONCLUSION Sigmoid sinus injury can be well managed with long-term patency by utilizing different repair techniques. Initial safe and adequate exposure around the injury site was essential for all of these repair procedures.