Anterior location and complex trauma are associated with higher mortality in superior sagittal sinus injuriesPenetrating Brain Sinus Injuries: 27% Mortality in 51 Cases

Frontiers in Medicine Published June 16, 2026 DOI ↗ Editorial oversight: Dr. Ji-eun Park, MD · Brain, Mind & Pain

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Key Takeaway

Note that anterior third involvement and complex trauma are associated with higher mortality in superior sagittal sinus injuries.

This systematic review analyzes 51 cases of penetrating injuries to the superior sagittal sinus (pSSSIs) resulting from military trauma, accidents, suicides, and assaults. The study characterizes these injuries based on mechanism, anatomical location, surgical management techniques, and patient outcomes over a historical period.

Key findings indicate that the middle third is the most commonly involved segment (67%), followed by the anterior (24%) and posterior (18%) segments. Mortality was reported at 27%, with higher mortality rates specifically associated with injuries to the anterior third and cases involving complex trauma. Common penetrating objects included nails (24%), bone fragments (16%), and bullets (16%).

Repair methods varied significantly, including hemostatic agents (25%), grafts (25%), ligation (14%), and sutures (14%). The authors note that no standardized management paradigm currently exists for these injuries. Clinical practice is limited by the lack of consensus guidelines, though the data highlights the importance of anatomical site and timely intervention in determining patient outcomes.

A systematic review of 51 cases of penetrating injuries to the superior sagittal sinus (pSSSIs) found a 27% mortality rate. The study, which looked at cases from military trauma, accidents, suicides, and assaults, provides a detailed picture of these rare but serious injuries.

Most patients were male (96%) with an average age of 30. The middle third of the sinus was most often involved (67%). Common penetrating objects included nails (24%), bone fragments (16%), and bullets (16%). Repair methods varied, with hemostatic agents and grafts each used in 25% of cases.

Mortality was higher in injuries to the anterior third of the sinus and in complex trauma. However, the authors note that no standardized management paradigm currently exists for these injuries, and the findings are based on a small number of cases over two centuries.

This review highlights factors that may influence outcomes, such as the anatomical site and mechanism of injury. It underscores the need for consensus guidelines, but readers should remember that this is an observational review, not a controlled trial, and individual cases vary widely.

What this means for you:

A review of 51 cases shows 27% mortality, but no standard treatment guidelines exist yet.

Common questions

What is the superior sagittal sinus?

It is a large vein that runs along the top of the brain, draining blood from the brain's surface. Injuries to it can be life-threatening.

What causes penetrating injuries to this sinus?

In this review, causes included military trauma (33%), accidents (29%), suicides (18%), and assaults (8%). Common objects were nails, bone fragments, and bullets.

What is the mortality rate for these injuries?

The review found a 27% mortality rate overall. Mortality was higher in injuries to the front part of the sinus and in complex trauma.

How are these injuries treated?

Treatment varied: hemostatic agents (25%), grafts (25%), ligation (14%), and sutures (14%). No standard treatment guidelines exist yet.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedJun 2026

View Original Abstract ↓

ObjectivePenetrating injuries of the superior sagittal sinus (pSSSIs) are rare but catastrophic, often causing massive hemorrhage, intracranial hypertension, and neurological decline. Despite centuries of reported cases, management guidance remains fragmented. This study reports a systematic literature review that sought to characterize pSSSIs by mechanism, anatomical involvement, surgical management, and outcomes and trace the evolution of repair techniques over 2 centuries.MethodsPubMed, Embase, Scopus, and Cochrane databases were searched in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion criteria targeted original reports of pSSSIs, excluding iatrogenic or nonpenetrating trauma. Study quality was assessed using the Joanna Briggs Institute tools.ResultsThirty-nine articles describing 51 cases for the period 1826–2025 were included. Patients were predominantly male (49 of 51; 96%) with a mean (SD) age of 30.3 (15.1) years. Causes included military trauma (33%), accidents (29%), suicides (18%), and assaults (8%). The middle third of the sinus was most often affected (67%), followed by the anterior (24%) and posterior (18%) thirds. Nails (24%), bone fragments (16%), and bullets (16%) were frequent penetrating objects. Repair methods included hemostatic agents (25%), grafts (25%), ligation (14%), and sutures (14%). Mortality was 27% and was highest among individuals with injuries to the anterior third of the sinus and those with complex trauma.ConclusionpSSSIs are uncommon but life-threatening, with outcomes determined by the anatomical site, mechanism, and timely intervention. Although surgical management options have evolved, no standardized paradigm exists. Contemporary approaches emphasize tailored combinations of direct repair, reconstruction, and selective ligation. Further work is needed to establish consensus guidelines and optimize outcomes in these challenging cases.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420251124767, identifier (CRD420251124767).

Anterior location and complex trauma are associated with higher mortality in superior sagittal sinus injuriesPenetrating Brain Sinus Injuries: 27% Mortality in 51 Cases

Common questions

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Anterior location and complex trauma are associated with higher mortality in superior sagittal sinus injuriesPenetrating Brain Sinus Injuries: 27% Mortality in 51 Cases

Common questions

Study Details

Intravenous tenecteplase improves functional outcomes but increases hemorrhage risk in non-large vessel occlusion acute ischemic stroke

Tenecteplase improves stroke recovery but increases bleeding risk in late treatment window

Clinical research that matters. Delivered to your inbox.

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