Fracture of skull base
Basal skull fracture is a serious injury, accompanied by fracture of one or more
bones belonging to the base of the skull brain - the occipital, temporal, ethmoid, sphenoid.
Such injuries are statistically rare, accounting for only 4% of the number of severe traumatic brain injury, and voznikayutchasche of all car accident, fall from a great height, as well as strong shocks in the nose or lower jaw.
Fracture of skull base accompanied by damage to membranes of the brain that causes the expiration of the cerebrospinal fluid (CSF) through the nasal and oral cavities, orbit, middle ear cavity. In most cases this leads to posttravmaticheskoypnevmotsefalii - infection intracranial contents due to the penetration of pathogens.
Anatomy of a fracture of the skull base
Fractures of the base of the skull divided napovrezhdeniya the front and the back of his base. The first type of fractures are injuries of the temporal, occipital and posterior parts of the sphenoid bone. The second - ethmoid fractures and sphenoid. The most common of these is the temporal bone fracture (over 75%), depending on the position of the line relative to the longitudinal axis of the damaged pyramid temporal bone may be transverse, longitudinal and mixed.
Occipital bone fractures are associated with a high risk of damage to major blood vessels, nerves and spinal cord. Damage to the cranial nerves are fraught with oculomotor palsy and facial nerves or hearing loss due to injury vestibulocochlear nerve.
Symptoms of a fracture of the skull base are:
- Bleeding from the ears or nose;
- Expiration of liquor from the ears (otolikvoreya) or nose (rinolikvoreya);
- Cluster spotting in the tympanic cavity;
- Symptom "points" (the so-called "raccoon eyes") - periorbital ecchymosis;
- Symptom-Battle in the ecchymosis of the mastoid process of the temporal bone;
- Vomiting, nystagmus, hearing loss;
- Visual impairment - in the case of broken bones crushing the optic nerve;
- Violations of the vital functions: hemodynamics, breathing.
Consequences of fracture of the skull base
Fracture of skull base - is a danger of injury, destructive for the brain and for the spinal cord, since the base of the skull is the unifying element throughout the central nervous system. Consequences of fracture of the skull base may be different, ranging from small curvature of the spine, frequent headaches
pain, uncontrollable high blood pressure, ending meningitis, encephalitis, full body paralysis or death.
The quality of life of the victim, who suffered a fracture of the skull base, depending on the nature and severity of traumatic brain injury, the presence of infection mater, comorbidities.
Treatment of fractures of the skull base
Patients should carry out the treatment of fractures of the skull base in the neurosurgical ward. There are conservative and surgical treatments. The leading role in the conservative method of treatment takes prevention of intracranial complications, for which immediately after admission to the hospital is administered intravenously, intramuscularly, or endolyumbalnoe subarachnoid administration of drugs, broad-spectrum antibiotics.
In cases of depressed lesions penetrating the side and front parabasal sinus, comminuted fracture of the anterior cranial fossa conservative treatment is pointless. Surgical methods are also treated recurrent intracranial suppurative complications nazalnayalikvoreya. However, in each case, a decision on the need for surgery takes an experienced neurosurgeon.