A 15-year-old adolescent was admitted to the emergency department after a car accident because of severe traumatic brain injury. Upon arrival, he was sedated and intubated because of a Glasgow Coma Scale score below 8. He had isocoria with reactive pupils. An occipital puncture wound (diameter 2 cm) was profusely bleeding. His blood pressure was 85/45 mm Hg. Laboratory values identified a haemoglobin level of 4.6 mmol/l. A CT scan of the brain demonstrated a comminuted-depressed fracture of the parietal bone in the midline with a rupture of the superior sagittal sinus (SSS) and secondary thrombosis (figure 1). After prompt resuscitation including packed blood cells, a large biparietal decompressive craniectomy was performed centred at the skull fracture anticipating on intracranial hypertension due to venous oedema or infarction. The sinus haemorrhage was initially packed with haemostatic material and manually compressed with cottonoids and spatula until the roof of the sinus was reconstructed using inverted dural flaps. …