Since the advent of antibiotics, this disease has become rare, occasionally occurring in those who delay seeking medical treatment or have immune deficiencies. Gui Shiji (1983) reported one such case. Suwen

bubble_chart Etiology

Acute frontal sinusitis, acute frontal osteomyelitis, subgaleal abscess, or infectious trauma to the forehead can cause thrombophlebitis in the superior sagittal sinus when bacteria enter through the frontal diploic veins or anterior temporal diploic veins. Epidural abscess can also lead to this condition.

bubble_chart Pathological Changes

It varies depending on the disease cause and route of infection. For cases caused by inflammation of the frontal and ethmoid sinuses or frontal osteomyelitis, due to the favorable blood flow direction, bacteria or infected thrombi can enter the sagittal sinus with the blood, leading to vasculitis, endothelial detachment, and thrombus formation due to slow blood flow. Right-sided otogenic sigmoid sinus thrombosis can spread against the blood flow to the superior sagittal sinus, but this progression is relatively slow. The thrombus initially forms along the vessel wall, gradually enlarging until the entire venous sinus is occluded. Since the sagittal sinus receives superficial venous blood from the parietal lobes of both cerebral hemispheres, infectious thrombi can spread to bilateral cortices, causing multiple focal encephalitis or superficial abscesses, as well as meningitis or subdural abscesses. With timely treatment, if the infection is controlled and the inflammation stops progressing, the thrombus may organize and gradually resolve, restoring blood flow. Wall-adherent thrombi resolve more quickly and are particularly prone to revascularization.

In addition to primary nasal conditions, the patient exhibits shivering, fever, night sweats, as well as clinical manifestations of meningeal irritation and septicemia such as headache and vomiting. Swelling and tenderness may appear at the midline of the vertex, and the patient may experience paroxysmal localized epilepsy alternating between the left and right sides, followed by hemiplegia and abducens nerve paralysis, known as superior sagittal sinus syndrome. As the condition progresses, hemiplegia may extend from the lower limbs to the upper limbs, with severe cases presenting symptoms such as unconsciousness and aphasia. Lumbar puncture may reveal increased intracranial pressure and meningeal reactions, along with elevated white blood cell count in the blood.

bubble_chart Diagnosis

Superior sagittal sinus thrombophlebitis is easily overlooked due to its rarity. The following signs can serve as diagnostic references:

1. Acute frontal sinusitis with edema and tenderness in the corresponding area of the superior sagittal sinus.

2. Multiple abscesses along the cranial sutures.

3. Septicemia accompanied by superior sagittal sinus syndrome.

bubble_chart Treatment Measures

Large doses of antibiotic injections, such as new penicillin, cephalosporin, lincomycin, etc., and seasonal epidemic frontal sinus radical surgery to remove necrotic bone in the frontal region. For epidural abscesses or subgaleal abscesses, timely incision and drainage with thorough irrigation of the purulent cavity should be performed.

Brain abscesses complicating superior sagittal sinus thrombophlebitis are all very superficial. CT-guided puncture and drainage can be performed, and hyperosmotic agents to reduce intracranial pressure can be used for cerebral edema.