Penetrating injuries of the posterior dural venous sinuses: a systematic review of injury mechanisms and repair techniques.

UNLABELLED: Penetrating injuries to the posterior dural venous sinuses (DVSs), which include the transverse sinus, sigmoid sinus, and torcular Herophili, are rare, life-threatening events with no standardized management protocols. This study aims to elucidate the injury mechanisms, management strategies, and outcomes associated with these injuries. A systematic review of all reported cases of penetrating posterior DVS injury was conducted on February 08, 2026. The systematic review yielded 10 studies comprising 43 patients. Demographic data were reported for eight of these 43 patients (18.6%). Seven (87.5%) of these patients were male, and one (12.5%) was female. Mean (SD) patient age was 25.8 (16.6) years (range, 5-52 years). The most common mechanism of injury was penetrating injury (38 of 43, 88.4%). The transverse sinus was the most frequently injured sinus (83.7%); reported management techniques for transverse sinus injuries included suture repair, grafting, and packing. Sigmoid sinus injuries were identified in five of 43 patients (11.6%); most of these injuries were managed with tamponade, but one patient (20%) died. Torcular Herophili injuries were rare (2 of 43 patients, 4.7%) and often hemodynamically unstable. Direct repair (e.g., suture, patch, or graft) was associated with improved survival. These reports showed that management of penetrating posterior DVS injuries may be tailored to the sinus involved, and evidence supports reconstructive strategies to preserve venous outflow whenever possible. Although transverse sinus ligation may be tolerated in cases of contralateral dominance, sigmoid sinus injuries are associated with poorer outcomes and were typically managed with tamponade. In contrast, patients with torcular Herophili injuries were shown to have favorable outcomes when repaired to preserve flow. This integrated review provides a foundational framework for managing complex venous sinus injuries in high-acuity settings. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD420251133849, identifier: CRD420251133849.