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Carazo Casas C, Medina Gonzalez M. Hemotympanum with a Basilar Skull Fracture. N Engl J Med 2024; 390:e38. [PMID: 38624022 DOI: 10.1056/nejmicm2313061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
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2
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Seddon K, Low C. Osteomyelitis following an undisplaced basal skull fracture. N Z Med J 2020; 133:73-76. [PMID: 32027641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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3
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Abstract
INTRODUCTION Acute hydrocephalus is a common complication of spontaneous or traumatic intracranial bleeding with extensive subarachnoid hemorrhage (SAH) or ventricular extension. However, it has never been reported to be secondary to pneumocephalus. PATIENT CONCERNS A 32-year-old man was admitted following a motorcycle accident. Head computed tomography (CT) performed right after the accident revealed a skull base fracture and mild perimesencephalic SAH. Three days later, repeated CT revealed delayed perimesencephalic pneumocephalus and an evident enlargement of the ventricular system. DIAGNOSIS The patient was diagnosed with acute obstructive hydrocephalus, which was secondary to pneumocephalus and traumatic SAH. INTERVENTIONS The patient was treated with temporary external ventricular drainage (EVD). OUTCOMES The patient experienced an unremarkable recovery process. At follow-up 3 months later, he showed no recurrence of the hydrocephalus and the score of Glasgow Outcome Scale was 5. CONCLUSION Transient mechanical obstruction of CSF circulation and disturbance of CSF physiology might conjointly lead to the acute obstructive hydrocephalus.
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Affiliation(s)
| | - Guangming Wang
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Tengfei Luan
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Kun Hou
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Jinlu Yu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin, China
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4
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Andersson D, Kjellén G. [Oculorrhea after facial fracture and anterior skull base fracture]. Lakartidningen 2016; 113:DUWW. [PMID: 26928686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Leakage of cerebrospinal fluid (CSF) from a cranio-orbital fistula, i.e. oculorrhea, is rare after skull trauma with fewer than 30 patients reported in Western literature. Here, we for the first time report a Swedish patient. A 75-year-old male sustained a mid-facial injury due to a bicycle accident. The CT-scan showed, among other things, a fracture in the orbital roof, involving lamina cribrosa and lamina papyracea. The patient had epiphora and laboratory analysis showed CSF leakage. This diagnosis should be kept in mind when excessive tearing appears in mid-facial trauma and treatment should be considered, otherwise serious complications may occur.
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Affiliation(s)
- Daniel Andersson
- Länssjukhuset i Kalmar - Öron-näs- och halskliniken Kalmar, Sweden - Kalmar, Sweden
| | - Gerhard Kjellén
- Länssjukhuset i Kalmar - Öron- näs- och halskliniken Kalmar, Sweden Öron- näs- och halskliniken - Kalmar, Sweden
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5
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Gordts F, Foulon I, Hachimi-Idrissi S. Basilar skull fractures: the petrous bone. B-ENT 2016; Suppl 26:193-201. [PMID: 29461743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
UNLABELLED Basilar skullfractures: the petrous bone. OBJECTIVES to provide suggestions for the management of three of the most dangerous or important lesions (internal carotid artery lesions, cerebrospinal fluid leaks and facial nerve paralysis) associated with the petrous part of basilar skull fractures, thereby trying to assess categories of evidence and determine strengths of recommendation. METHODOLOGY A PubMed-based literature review was carried out, as well as a consultation of online sources as encountered in the literature review. Also, a non-systematic search of chapters of well-known books dealing with the subject of temporal bone traumata was conducted. RESULTS Specific levels of evidence and/or strength of recommendation can be retrieved from the literature, but only with respect to the prophylactic use of antibiotics, the prescription of antithrombotic medications and the indications for angiography. CONCLUSION The ample amount of available literature allows for sound management decisions, with reference made to algorithms when available in the literature. Nevertheless, for most of the management/search questions, categories of evidence and strength of recommendation are low or lacking.
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6
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Park GY, Choi JE, Cho YS. Traumatic ossicular disruption with isolated fracture of the stapes suprastructure: comparison with incudostapedial joint dislocation. Acta Otolaryngol 2014; 134:1225-30. [PMID: 25279533 DOI: 10.3109/00016489.2014.939302] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION More severe high frequency hearing loss, especially at 8 kHz, occurs with fracture of the stapes suprastructure (SSF) compared with isolated incudostapedial joint dislocation (ISD). Successful hearing gain can be achieved in the speech range with appropriate ossicular reconstruction. OBJECTIVES Traumatic SSF is a rare consequence of head trauma. This study aimed to demonstrate the characteristic features of SSF compared with traumatic ISD. METHODS Eighteen patients who suffered from conductive hearing loss after head trauma and were operated from 2000 to 2012 were enrolled. Eight and 10 patients were confirmed to have a traumatic SSF (SSF group) and ISD (ISD group), respectively. The etiology of ossicular disruption, preoperative CT scan of the temporal bone, and intraoperative findings were retrospectively reviewed. Pre- and postoperative hearing was analyzed by both pure tone averages and thresholds at each frequency (0.5-8 kHz). RESULTS The most common etiologies in the SSF group were fall (n = 3) and direct ear trauma (n = 3), and for those in the ISD group, the most common etiology was traffic accident (n = 6). CT scan showed no evidence of fracture in the SSF group, whereas findings of ossicular dislocation were found in 70% of patients in the ISD group. Hearing outcomes according to the frequencies demonstrated that pre- and postoperative hearing loss at 8 kHz was more severe in the SSF group than in the ISD group. In a comparison of hearing outcomes at each frequency, the postoperative hearing threshold at 8 kHz was higher than for other frequencies. Postoperatively, 63% of the SSF group and 70% of the ISD group obtained an air-bone gap of within 15 dB.
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Affiliation(s)
- Ga Young Park
- Department of Otorhinolaryngology - Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Korea
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7
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Gelabert-González M, Arán-Echabe E. [Battle's sign]. Rev Neurol 2013; 57:282. [PMID: 24008939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Miguel Gelabert-González
- Servicio de Neurocirugía, Hospital Clinico de Santiago de Compostela, 15706 Santiago de Compostela, Espana.
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9
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Izvin AI, Kuznetsova NE, Siniakov AI. [A rare case of a gunshot wound in the ethmoid bone with the right-hand frontobasal skull fracture]. Vestn Otorinolaringol 2011:70-72. [PMID: 21598453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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10
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Abstract
In trauma practice, basilar skull fracture is an extremely common finding while transverse/sigmoid venous sinus thrombosis is generally considered quite a rare complication. During evaluation of cervical computed tomography (CT) angiography after trauma, we identified five patients in just three months with unexpected transverse/sigmoid venous sinus obstruction ipsilateral to a basilar skull fracture. This number represented a surprisingly high percentage of our neurosurgical trauma consults for the study period (31%). Three of the five patients were found to have sinus thrombosis: two with right transverse/sigmoid sinus thrombosis experienced significant neurological deficits and prolonged hospital courses even with anti-coagulation therapy; one patient with a left transverse/sigmoid sinus thrombosis had a good outcome with anti-coagulation therapy. The other two of the five patients had outflow obstruction, likely from focal epidural bleeding and extrinsic compression: one patient with partial obstruction in the right transverse-sigmoid junction, due to epidural bleeding, experienced a difficult recovery; one patient with a right sigmoid sinus obstruction presented and remained asymptomatic and experienced a benign hospital course. Two of the five patients had a posterior temporal hemorrhagic area ipsilateral to the affected sinus, suggesting that this finding may have represented hemorrhagic venous infarction rather than traumatic contusion. We propose that a basilar skull fracture in the region of temporal or occipital bone should be considered as a significant risk factor for the development of transverse/sigmoid venous sinus obstruction and may be an under-recognized and treatable cause of increased intracranial pressure. Failure to detect this complication may explain, in part, unexpected clinical outcomes.
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Affiliation(s)
- Xueren Zhao
- Inova Regional Neurosurgery Service, Department of Neuroscience, Inova Fairfax Hospital, Falls Church, Virginia, USA
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11
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Katsuno M, Yokota H, Yamamoto Y, Teramoto A. Bilateral traumatic abducens nerve palsy associated with skull base fracture--case report. Neurol Med Chir (Tokyo) 2007; 47:307-9. [PMID: 17652916 DOI: 10.2176/nmc.47.307] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 29-year-old man presented with skull base fractures involving the bilateral petrous bones and clivus to the posterior clinoid process manifesting as bilateral abducens nerves palsy. Conservative treatment resulted in residual bilateral abducens nerves palsy. Posterolateral impact probably resulted in strain-stress in the neighborhood of the foramen lacerum, resulting in a clivus fracture of the posterior clinoid process and bilateral petrous bone fractures. Chalasia of Gruber's ligament then exerted mechanical pressure on the bilateral abducens nerves.
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Affiliation(s)
- Makoto Katsuno
- Department of Emergency and Critical Care, Nippon Medical School, Tokyo
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12
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Maras D, Lioupis C, Magoufis G, Tsamopoulos N, Moulakakis K, Andrikopoulos V. Covered stent-graft treatment of traumatic internal carotid artery pseudoaneurysms: a review. Cardiovasc Intervent Radiol 2007; 29:958-68. [PMID: 16897263 DOI: 10.1007/s00270-005-0367-7] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To review the literature concerning the management with placement of covered stent-grafts of traumatic pseudoaneurysms of the extracranial internal carotid artery (ICA) resulting from penetrating craniocervical injuries or skull base fractures. METHOD We have reviewed, from the Medline database, all the published cases in the English literature since 1990 and we have added a new case. RESULTS We identified 20 patients with traumatic extracranial ICA pseudoaneurysms due to penetrating craniocervical injuries or skull base fractures who had been treated with covered stent-graft implantation. Many discrepancies have been ascertained regarding the anticoagulation therapy. In 3 patients the ICA was totally occluded in the follow-up period, giving an overall occlusion rate 15%. No serious complication was reported as a result of the endovascular procedure. CONCLUSION Preliminary results suggest that placement of stent-grafts is a safe and effective method of treating ICA traumatic pseudoaneurysms resulting from penetrating craniocervical injuries or skull base fractures. The immediate results are satisfactory when the procedure takes place with appropriate anticoagulation therapy. The periprocedural morbidity and mortality and the early patency are also acceptable. A surveillance program with appropriate interventions to manage restenosis may improve the long-term patency.
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MESH Headings
- Adult
- Aneurysm, False/diagnostic imaging
- Aneurysm, False/etiology
- Aneurysm, False/surgery
- Anticoagulants/therapeutic use
- Blood Vessel Prosthesis Implantation
- Carotid Artery Injuries/diagnostic imaging
- Carotid Artery Injuries/etiology
- Carotid Artery Injuries/surgery
- Carotid Artery, Internal/diagnostic imaging
- Carotid Artery, Internal/surgery
- Coated Materials, Biocompatible/therapeutic use
- Combined Modality Therapy
- Graft Occlusion, Vascular/diagnostic imaging
- Graft Occlusion, Vascular/etiology
- Head Injuries, Penetrating/complications
- Head Injuries, Penetrating/diagnostic imaging
- Head Injuries, Penetrating/surgery
- Humans
- Male
- Polytetrafluoroethylene/therapeutic use
- Radiography
- Skull Fracture, Basilar/complications
- Skull Fracture, Basilar/diagnostic imaging
- Skull Fracture, Basilar/surgery
- Stents
- Vascular Patency
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Affiliation(s)
- Dimitrios Maras
- Department of Vascular Surgery, The Red Cross Hospital of Athens, Athens, Greece
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13
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Löwenheim H, Koerbel A, Nohé B, Bültmann E, Hirt B, Kaminsky J, Tatagiba M, Ernemann U. [Massive epistaxis with haemorrhagic shock in the late phase after skull-base fracture]. HNO 2007; 54:768-71. [PMID: 16283130 DOI: 10.1007/s00106-005-1343-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- H Löwenheim
- Klinik für Hals-Nasen-Ohren-Heilkunde, Universitätsklinikum Tübingen
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14
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Abstract
We describe the case of a foreign body lodged into ethmoidal labyrinth and sphenoidal sinus with fracture of the clivus and consequent rhinoliquorrhea removed by an endoscopic technique. We performed a skull base plasty to close the rhino-liquoral fistula with resolution of the rhinoliquorrhea. There were no postoperative complications and there was a good therapeutic result at long-term follow-up.
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Affiliation(s)
- L Presutti
- Department of Otorhinolaryngology, Polyclinic of Modena, Italy
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15
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Dashti R, Ulu MO, Albayram S, Aydin S, Ulusoy L, Hanci M. Concomitant fracture of bilateral occipital condyle and inferior clivus: what is the mechanism of injury? Eur Spine J 2006; 16 Suppl 3:261-4. [PMID: 17180399 PMCID: PMC2148078 DOI: 10.1007/s00586-006-0270-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2006] [Revised: 10/14/2006] [Accepted: 11/06/2006] [Indexed: 10/23/2022]
Abstract
With the routine use of multi-slice high resolution computed tomography, increasing number of occipital condyle fractures have been reported in the last decade. The authors report a very rare case of bilateral occipital condyle fracture complicated by the fracture of the inferior clivus and discuss the possible mechanisms of injury.
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MESH Headings
- Accidents, Traffic
- Adult
- Atlanto-Axial Joint/diagnostic imaging
- Atlanto-Axial Joint/injuries
- Atlanto-Axial Joint/pathology
- Atlanto-Occipital Joint/diagnostic imaging
- Atlanto-Occipital Joint/injuries
- Atlanto-Occipital Joint/pathology
- Cranial Fossa, Posterior/diagnostic imaging
- Cranial Fossa, Posterior/injuries
- Cranial Fossa, Posterior/pathology
- External Fixators
- Functional Laterality/physiology
- Head Injuries, Closed/diagnostic imaging
- Head Injuries, Closed/pathology
- Head Injuries, Closed/physiopathology
- Humans
- Ligaments/diagnostic imaging
- Ligaments/injuries
- Ligaments/pathology
- Magnetic Resonance Imaging
- Male
- Occipital Bone/diagnostic imaging
- Occipital Bone/injuries
- Occipital Bone/pathology
- Pneumothorax/complications
- Respiratory Distress Syndrome/complications
- Skull Fracture, Basilar/diagnostic imaging
- Skull Fracture, Basilar/pathology
- Skull Fracture, Basilar/physiopathology
- Subarachnoid Hemorrhage/complications
- Tomography, X-Ray Computed
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Affiliation(s)
- Reza Dashti
- Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University, P.O. Box: 9, Cerrahpasa, Aksaray, 34303, Istanbul, Turkey.
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Buis DR, Dirven CMF, van den Berg R, Manoliu RA, Vandertop WP. Air in the carotid canal as a predictor of distal internal carotid artery laceration. Acta Neurochir (Wien) 2006; 148:1201-3; discussion 1203. [PMID: 17031471 DOI: 10.1007/s00701-006-0900-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2005] [Accepted: 08/16/2006] [Indexed: 11/24/2022]
Abstract
The authors describe a 25-year old patient with blunt trauma-induced bilateral, distal segment internal carotid artery (ICA) lacerations, resulting in a left-sided direct carotid-cavernous sinus fistula (CCF) and presenting with massive oronasal bleeding. The combination of severe oronasal bleeding, with air in the carotid canal should alarm the treating physician to the presence of a distal internal carotid artery laceration.
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MESH Headings
- Accidents, Traffic
- Adult
- Bicycling
- Carotid Artery Injuries/diagnosis
- Carotid Artery Injuries/etiology
- Carotid Artery, Internal/pathology
- Carotid Artery, Internal/physiopathology
- Cavernous Sinus/diagnostic imaging
- Cavernous Sinus/injuries
- Cavernous Sinus/pathology
- Central Nervous System Vascular Malformations/diagnosis
- Central Nervous System Vascular Malformations/etiology
- Central Nervous System Vascular Malformations/physiopathology
- Cerebral Angiography
- Embolism, Air/diagnosis
- Embolism, Air/etiology
- Embolism, Air/physiopathology
- Embolization, Therapeutic
- Epistaxis/etiology
- Facial Bones/diagnostic imaging
- Facial Bones/injuries
- Facial Bones/pathology
- Fatal Outcome
- Head Injuries, Closed/complications
- Humans
- Lacerations/diagnosis
- Lacerations/etiology
- Lacerations/physiopathology
- Male
- Mouth/physiopathology
- Paranasal Sinuses/diagnostic imaging
- Paranasal Sinuses/injuries
- Paranasal Sinuses/pathology
- Predictive Value of Tests
- Skull Base/diagnostic imaging
- Skull Base/injuries
- Skull Base/pathology
- Skull Fracture, Basilar/diagnostic imaging
- Skull Fracture, Basilar/etiology
- Skull Fracture, Basilar/pathology
- Tomography, X-Ray Computed
- Treatment Failure
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Affiliation(s)
- D R Buis
- Department of Neurosurgery, VU University Medical Center, Amsterdam, The Netherlands.
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Affiliation(s)
- Oliver P Gautschi
- Department of Orthopedic and Trauma Surgery, Royal Perth Hospital, Perth, Western Australia 6000, Australia.
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Abstract
BACKGROUND High-velocity accidents cause significant injury to the cranial and facial skeleton. Frontobasal fractures include fractures of the upper third of the face and anterior skull base. The pattern and classifications of these fractures are poorly understood at present. The authors have attempted a new comprehensive classification based on detailed clinicoradiographic evaluation. METHODS A prospective study was undertaken in a tertiary care hospital in 1 calendar year (July of 2000 to June of 2001). All 63 patients with frontobasal fractures had detailed clinical and radiographic evaluation with plain radiographs and high-resolution computed tomographic scan. The fractures were classified as frontal, basal, and combined. Areas were separated as central (designated type 1) and lateral (designated type 2) to differentiate the pattern in the sagittal plane according to the site of impact. Combined fractures involving both central and lateral areas were designated type 3. These could be further classified into unilateral or bilateral or pure or impure, depending on the absence or presence of midfacial fractures. RESULTS The fractures were subdivided into nine types considering the whole lateral and anteroposterior extents of the frontobasal region. The most common was the combined frontobasal type (30.16 percent). We found the pure type in 38.1 percent (24 of 63) and the impure type in 61.9 percent (39 of 63) of patients. Cerebrospinal fluid leaks occurred more commonly in impure types of frontobasal fracture. Blunt trauma leading to closed frontobasal fracture was seen in 35 patients. Penetrating trauma with open fractures was found in 28 patients and cerebrospinal fluid leak through the wound was seen in six of them. CONCLUSIONS The new comprehensive classification clearly defines the anatomical areas within the frontobasal region, the nature of injury, and its association with midfacial injuries, and is helpful in planning the approach to their exposure in surgery.
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Affiliation(s)
- G Madhusudan
- Department of Plastic Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
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19
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Abstract
BACKGROUND Surgical management of multiple traumatized patients with head and neck trauma is highly individualized and depends on a number of factors including etiology, intracranial pressure, concomitant injuries, patient age and the possibility of an interdisciplinary procedure. Severe head and neck trauma are often connected with fractures of the frontal skull base or nasoethmoido-orbital complex and CSF leakage. If there is suspicion of a CSF leakage surgical management to cover the dura-defect is essential. An intradural approach is necessary in case of concomitant intradural injuries while primary extradural access provides excellent exposure of the rhinobasis with low morbidity and good results. METHODS AND MATERIAL We report about our surgical experiences of 55 patients with severe frontobasal trauma, who were operated between 1/1999 and 11/2003. The subfrontal approach according to Raveh we had chosen in 20 patients which were operated by an interdisciplinary team together with the neurosurgeons. With an average follow up of 36 month we report about early and late complications. RESULTS 19/20 patients showed sufficient coverage of the CSF leakage, once a revision surgery was necessary. Finally this patient had also an unobjectionable coverage of the CSF leakage. We saw no major complication like meningitis or brain abscess, intracerebral haematoma or surgical injury of the orbital wall. The most important complication was an anosmia, which depending on the extension of the approach results in any patients. CONCLUSIONS Our results show that the subfrontal approach is a reliable method to explore extensive frontal dural defects and to reconstruct fractures of the frontal skull base without additional trauma to the frontal lobe.
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Affiliation(s)
- A Sandner
- Klinik für Hals-Nasen-Ohrenheilkunde und Kopf-Hals-Chirurgie der Martin-Luther-Universität Halle-Wittenberg.
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20
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MESH Headings
- Adult
- Carotid Artery, Internal/diagnostic imaging
- Cranial Fossa, Posterior/diagnostic imaging
- Cranial Fossa, Posterior/injuries
- Facial Bones/diagnostic imaging
- Facial Bones/injuries
- Follow-Up Studies
- Frontal Sinus/diagnostic imaging
- Frontal Sinus/injuries
- Humans
- Image Processing, Computer-Assisted
- Imaging, Three-Dimensional
- Male
- Maxillary Fractures/diagnostic imaging
- Patient Care Planning
- Patient Care Team
- Skull Fracture, Basilar/diagnostic imaging
- Skull Fracture, Basilar/therapy
- Sphenoid Sinus/diagnostic imaging
- Sphenoid Sinus/injuries
- Tomography, X-Ray Computed
- Wounds, Nonpenetrating/diagnostic imaging
- Wounds, Nonpenetrating/therapy
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Affiliation(s)
- Maurizio A Miglietta
- New York University School of Medicine, Department of Surgery and Trauma Radiology, Bellevue Trauma & Shock Unit, New York, NY 10016, USA.
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21
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Abstract
Anterior skull base trauma evaluation and management has historically been difficult to systematically study secondary to the relative rarity of its occurrence, associated major morbidity and high mortality, and poor radiographic techniques. It has only been recently that improved care has allowed for decreased morbidity and mortality. The advent of computed tomography imaging techniques has led to anatomic characterization and detailed study of injury patterns. This article reviews current techniques for evaluation and management of the associated sinonasal, orbital, and neurologic sequelae of anterior skull base injuries.
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Affiliation(s)
- Matthew A Kienstra
- Department of Otolaryngology/Head and Neck Surgery, University of South Florida, Tampa, Florida 33612, USA
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22
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Abstract
This report describes a pediatric case of delayed glossopharyngeal nerve, vagus nerve, and facial nerve palsies after a head injury. Computed tomography scan of the skull base revealed the fracture of the petrous part of the temporal bone, and the fracture involved the tip of petrous pyramid, in front of the jugular foramen. The anatomical features, mechanisms, diagnosis, and treatment are discussed.
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Affiliation(s)
- Altan Yildirim
- Otolaryngology and Head Neck Surgery Department, Cumhuriyet University Medical Faculty, Sivas, Turkey.
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23
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Ramaswamy R, Macarthur D, White BD. Vascular threat in base of skull fractures. Br J Neurosurg 2004; 18:197-8. [PMID: 15176567 DOI: 10.1080/02688690410001681118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- R Ramaswamy
- Department of Neurosurgery, Queen's Medical Centre, Nottingham, UK.
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25
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Detante O, Colle F, Vu P, Pradat-Diehl P. [Pontine infarct after fracture of the skull base]. Rev Neurol (Paris) 2003; 159:326-8. [PMID: 12703052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
We report a case of pontine infarct that occurred after facial trauma with a fracture of the skull base. Reports of trauma-induced pontine infarcts have generally involved cervical trauma. This is the first report to our knowledge after facial trauma with skull base fracture. We suggest that intracranial vertebro-basilar dissection could be a possible mechanism.
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Affiliation(s)
- O Detante
- Service de Rééducation Neurologique, Hopital Pitié-Salpêtrière, Paris
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26
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Ouma JR. Recurrent meningitis due to unrecognised skull fracture. S Afr Med J 2002; 92:778-9. [PMID: 12432796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023] Open
Affiliation(s)
- J R Ouma
- Department of Neurosurgery, University of the Witwatersrand and Johannesburg General Hospital, Johannesburg
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27
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Abstract
The singular anatomical relationship of the base of the skull is responsible for the particular problems that may arise after injury. Extensive dural laceration and severe neurovascular damage may accompany skull base injuries. Trauma to the anterior skull base is frequently related to the paranasal sinuses, and trauma to the middle and the posterior skull base usually affects the petrous bone. Injury to the anterior fossa including the paranasal sinuses may produce CSF leakage, damage the olfactory nerves, optic nerves, and orbita contents. Fractures may affect the carotid canal, injure the internal carotid artery and result in carotid-cavernous fistula. Trauma to the petrous bone may cause facial palsy and deafness, and CSF leakage with otorrhoea or paradoxal rhinoliquorrhoea. Trauma to the posterior fossa may lacerate the major venous sinuses, and affect the cranio-cervical stability. Each one of these injuries will need a particular strategy. Decision making for management as a whole must consider all aspects, including the fact that these injuries frequently involve polytraumatized patients. Decisions regarding the timing of surgery and the sequence of the surgical procedures must be made with great care. Modern surgical techniques and recent technologies including functional preservation of the olfactory nerves in frontobasal trauma, visual evoked potentials, assisted optic nerve decompression, facial nerve reconstruction, interventional technique for intravascular repair of vascular injuries, and recent developments in cochlea implants and brain stem implants, all contributed significantly to improve outcome and enhance the quality of life of patients. This article reviews basic principles of management of skull base trauma stressing the role of these advanced techniques.
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Affiliation(s)
- Madjid Samii
- Department of Neurosurgery, Hannover College of Medicine, Carl-Neuberg-Strasse 1, D-30625 Hannover, Germany
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Sato S, Iida H, Hirayama H, Endo M, Ohwada T, Fujii K. Traumatic basilar artery occlusion caused by a fracture of the clivus--case report. Neurol Med Chir (Tokyo) 2001; 41:541-4. [PMID: 11758706 DOI: 10.2176/nmc.41.541] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 56-year-old man presented with a rare traumatic basilar artery occlusion caused by a fracture of the clivus. He fell from the height of 2 meters and immediately fell into a coma. Head computed tomography (CT) revealed an open depressed fracture, an acute epidural hematoma 1 cm thick in the left middle frontal fossa, and a longitudinal fracture of the clivus. Emergency removal of the hematoma was performed with cranioplasty. Head CT 8 hours 50 minutes after injury showed infarctions in the brain stem, cerebellum, and occipital lobes. Cerebral angiography revealed occlusion of the basilar artery in the middle part of the clivus. The patient died after 3 days. Autopsy revealed that the basilar artery was trapped in the clivus fracture site. Vertebrobasilar artery occlusion due to trapping in a clivus fracture has a very poor prognosis. Diagnosis is difficult and generally only confirmed at autopsy. Cerebral angiography is recommended in a patient in a deep coma without massive brain contusion at the early stage of head injury to identify the possibility of vertebrobasilar artery occlusion in a clivus fracture.
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Affiliation(s)
- S Sato
- Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
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Kästner S, Schroth I, Deinsberger W, Böker DK. [Delayed appearance of posttraumatic cerebrospinal fluid fistulas as a cause of recurrent meningitis]. Nervenarzt 2001; 72:307-11. [PMID: 11320867 DOI: 10.1007/s001150050755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Immediate post-traumatic fistulas with rhinorrhea are well known after head injury with frontobasal trauma. Less attention is paid to the possibility of delayed onset of rhinorrhea after severe head injury. Unrecognised frontobasal injury may cause recurrent meningitis due to communication of CSF with the outside world. In the last 5 years, seven patients who developed rhinorrhea 2-25 years after trauma were treated in our department. All patients had been through at least two episodes of meningitis. Intermittent rhinorrhea was reported by four. In all cases, coronal bone window CT scan disclosed a bony defect of the anterior skull base, and in three cases an encephalocele was revealed on MRI. Treatment consisted of reconstruction of the anterior skull base with a pedicled galeal-pericranial flap via bifrontal craniotomy. Delayed traumatic CSF fistulas are not rare but must be considered in the differential diagnosis of recurrent meningitis.
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Affiliation(s)
- S Kästner
- Neurochirurgische Klinik, Justus-Liebig-Universität Giessen.
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Shi Z, Huang Z, Lin C, Qi T, Chu M, Zhang X. Treatment of recurrent traumatic carotid cavernous fistula via endovascular embolism technique. Chin J Traumatol 2001; 4:51-4. [PMID: 11835711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- Z Shi
- Department of Neurosurgery, 1st Affiliated Hospital, Harbin Medical University, Harbin 150001, China
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Abstract
Posttraumatic cranio-orbital cerebrospinal fluid (CSF) fistula is very rare. Diagnosis of these fistulas may be difficult, and it is possible that this complication of craniofacial injury is underdiagnosed. Early recognition and adequate treatment is of paramount importance to prevent hazardous complications. The authors report the case of a 20-year-old woman in whom a CSF leak developed through the medial canthus area of her eye after she sustained a mild sports-related injury. Clinical examination and chemical analysis of the fluid led to the correct diagnosis, and the leak was stopped with conservative treatment. It is proposed that a CSF leak through the eye be termed “oculorrhea” as compared with otorrhea and rhinorrhea. The mechanism of the fistula in this patient is discussed, as is the pertinent radiologically demonstrated anatomy and the mechanism of injury. Management and controversies are also discussed.
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Affiliation(s)
- K Salame
- Department of Neurosurgery, Sourasky Medical Center, Sackler, School of Medicine, Tel Aviv University, Tel Aviv, Israel.
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32
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Dahiya R, Keller JD, Litofsky NS, Bankey PE, Bonassar LJ, Megerian CA. Temporal bone fractures: otic capsule sparing versus otic capsule violating clinical and radiographic considerations. J Trauma 1999; 47:1079-83. [PMID: 10608536 DOI: 10.1097/00005373-199912000-00014] [Citation(s) in RCA: 139] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the practicality and utility of the traditional classification system for temporal bone fracture (transverse vs. longitudinal) in the modern Level I trauma setting and to determine whether a newer system of designation (otic capsule sparing vs. otic capsule violating fracture) is practical from a clinical and radiographic standpoint. METHODS The University of Massachusetts Medical Center Trauma Registry was reviewed for the years 1995 to 1997. Patients identified as sustaining closed head injury were reviewed for basilar skull fracture and temporal bone fracture. Clinical and radiographic records were evaluated by using the two classification schemes. RESULTS A total of 2,977 patients were treated at the trauma center during this time. Ninety (3%) patients sustained a temporal bone fracture. The classic characterization of transverse versus longitudinal fracture (20% vs. 80%, respectively) was unable to be determined in this group; therefore, clinical correlation to complications using that paradigm was not possible. By using the otic capsule violating versus sparing designation, an important difference in clinical sequelae and intracranial complications became apparent. Compared with otic capsule sparing fractures, patients with otic capsule violating fractures were approximately two times more likely to develop facial paralysis, four times more likely to develop CSF leak, and seven times more likely to experience profound hearing loss, as well as more likely to sustain intracranial complications including epidural hematoma and subarachnoid hemorrhage. CONCLUSION The use of a classification system for temporal bone fractures that emphasizes violation or lack of violation of the otic capsule seems to offer the advantage of radiographic utility and stratification of clinical severity, including severity of Glasgow Coma Scale scores and intracranial complications such as subarachnoid hemorrhage and epidural hematoma.
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MESH Headings
- Cerebrospinal Fluid Otorrhea/etiology
- Cochlea/injuries
- Ear, Inner/injuries
- Facial Paralysis/etiology
- Female
- Fractures, Bone/classification
- Fractures, Bone/complications
- Fractures, Bone/diagnostic imaging
- Glasgow Coma Scale
- Head Injuries, Closed/complications
- Head Injuries, Closed/diagnostic imaging
- Hearing Disorders/etiology
- Hematoma, Epidural, Cranial/etiology
- Humans
- Male
- Registries
- Reproducibility of Results
- Retrospective Studies
- Skull Fracture, Basilar/complications
- Skull Fracture, Basilar/diagnostic imaging
- Subarachnoid Hemorrhage/etiology
- Temporal Bone/injuries
- Tomography, X-Ray Computed
- Trauma Centers
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Affiliation(s)
- R Dahiya
- Department of Otolaryngology-HNS, University of Massachusetts Medical School, Worcester 01655, USA
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Francis RA. Radiology quiz. Basilar skull fracture. Mo Med 1999; 96:489-90. [PMID: 10528498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Affiliation(s)
- R A Francis
- Diagnostic Imaging Department, Nevada Regional Medical Center, USA
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Affiliation(s)
- R S Moore
- Department of Accident and Emergency Medicine, Northampton General Hospital NHS Trust, Cliftonville
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