Turkish Neurosurgery
Stepwise Removal of The Fused Midline Parietal Bone to Avoid Superior Sagittal Sinus Injury in Infants with Sagital Synostosis
Tufan Hicdonmez1, Gaye Taylan Filinte2, Mehmet Tiryaki1, Yusuf Emrah Gergin1
1Dr. Lutfi Kirdar Educational and Research Hospital, Department of Neurosurgery, Istanbul,
2Dr. Lutfi Kirdar Educational and Research Hospital, Department of Plastic and Reconstructive Surgery, Istanbul,
DOI: 10.5137/1019-5149.JTN.16683-15.1

This work describes a simple technique for the safe removal of the midline parietal bone with the synostotic sagittal suture in infants with sagittal synostosis to avoid dural tearing and bleeding from the superior sagittal sinus. The technique consists of stepwise removal of the midline parietal bone in three pieces instead of one piece, starting with the anterior one-third midline bone being safely freed from the underlying dural sinus and then transversely cut using a craniotome. The step is repeated twice for the middle and distal one-third of the bone respectively. Once the midline bone is bilaterally cut along its entire length, the stepwise elevation of the superior sagittal sinus dura using an elevator and removal of the midline bone in three pieces allows a safer, controlled procedure minimizing the risk of tearing the underlying dural sinus and preventing sinus bleeding in infants with sagittal synostosis.

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