Lateral plating of the temporal bone: Hemostatic technique for complex transverse fractures of the petrous temporal bone

BACKGROUND: Transverse petrous temporal bone fractures are commonly associated with significant intracranial trauma. Diastases of these fractures can lead to issues with hemostasis in the setting of venous sinus or petrous internal carotid artery (ICA) injuries. OBJECTIVE: To describe a rare case of a severe displaced transverse petrous temporal bone fracture with impending intra-operative exsanguination, treated with fracture reduction and lateral plating in order to achieve hemostasis. METHODS: We retrospectively reviewed the records of a patient admitted to the neurosurgical department with a hyperacute epidural hematoma (EDH) secondary to a transverse petrous temporal bone fracture with venous sinus and petrous ICA injuries. RESULTS: A 22 year old male was admitted for a severe traumatic brain injury leading to a left displaced transverse petrous temporal bone fracture and a hyperacute EDH. Given the location of the fractures, injury to the venous sinus (at the area of the transverse-sigmoid junction) and petrous ICA was suspected. Intra-operatively, significant blood loss from both the venous sinus and petrous ICA was encountered. Given the displaced temporal bone fracture, packing of the areas was impaired. We performed a manual reduction of the temporal fracture, followed by lateral plating in order to achieve hemostasis from the petrous ICA and aid with packing of the venous sinus injury. CONCLUSIONS: Reduction and lateral plating of displaced transverse petrous temporal bone fractures can aid significantly with intra-operative hemostasis in the extreme case of venous sinus and/or petrous ICA injuries.