During canal wall down mastoidectomy for cholesteatoma, the surgeon identifies an exposed sigmoid sinus. Which intraoperative complication has just been recognized, and what is the immediate management?

• A Carotid artery injury — immediate ligation
• B Jugular bulb injury — tamponade with bone wax
• C Sigmoid sinus injury — pack with Surgicel/gelfoam and apply gentle pressure; avoid ligation ✓
• D Dural tear — immediate dural repair with temporalis fascia

Explanation

Sigmoid sinus dehiscence or injury during mastoidectomy is managed with direct pressure using absorbable hemostatic agents (Surgicel or Gelfoam). Ligation of the sigmoid sinus is rarely necessary and risks venous infarction. Bone wax is reserved for emissary veins. Awareness of the sinus position on preoperative CT prevents accidental entry into the sinus.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.