Successful repair of a gunshot wound to the head with retained bullet in the torcular herophili

BACKGROUND: Nonlethal missile injuries to the dural venous sinus system are rare. To date successful repair of isolated penetrating injury to the torcular herophili has not been reported without significant associated morbidity. We report the case of a gunshot wound injury to the occipital region with retained bullet fragment in the confluence of the sinuses causing traumatic sinus venous thrombosis. METHODS: Occipital and suboccipital craniotomy for removal of bullet in the torcula, repair of sinus defect, and repair of depressed skull bone fragments was performed. RESULTS: The procedure resulted in restoration of proximal and distal flow across the dural sinus system and preservation of torcular sinus patency with excellent neurological outcome. Technical considerations in the repair of penetrating torcular injuries are discussed. CONCLUSIONS: Gunshot wounds with retained bullet fragments in the torcula can be successfully repaired with preservation of neurological function after retrieval of metallic foreign body and restoration of venous sinus patency.