Abstract: Fractures of the basis cranii are usually the result of extension of a vault fracture. The most important complications associated with these fractures are cerebrospinal fluid CSF fistula, related infection, and pneumocephalus with fistula. CSF fistula involves the leakage of fluid from the subarachnoid space to the extraarachnoidal space through a defect in the arachnoidea, the dura, or the epithelial tissue. Although this leakage can occur along the cerebrospinal axis, it most often appears clinically as otorrhea and rhinorrhea. Meningitis is the most important complication of CSF fistulae.
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Abstract: Fractures of the basis cranii are usually the result of extension of a vault fracture. The most important complications associated with these fractures are cerebrospinal fluid CSF fistula, related infection, and pneumocephalus with fistula. CSF fistula involves the leakage of fluid from the subarachnoid space to the extraarachnoidal space through a defect in the arachnoidea, the dura, or the epithelial tissue.
Although this leakage can occur along the cerebrospinal axis, it most often appears clinically as otorrhea and rhinorrhea. Meningitis is the most important complication of CSF fistulae. We retrospectively studied 40 basis cranii fracture cases that were treated at our clink between November and December The most common cause of the fractures was traffic accident.
Tension pneumocephalus occurred in two cases during the time they were receiving treatment. Kaide kiriklarinin en nemli komplikasyonu BS fistl ve buna bagli olusan enfeksiyonlar ile pnmosefaluslardir. BS fistl, BS'un araknoid, dura veya epitel dokudaki defekte bagli subaraknoid mesafeden extraaraknoid mesafeye kaisidir.
Serebrospinal aks in herhangi bir yerinde grlse de en sik otore ve ri no re seklinde ortaya ikar. BS fistlnn en nemli komplikasyonu menenjittir. Klinigimizde kasim Aralik yillari arasinda tedavi edilen 40 kaide kirigi olgusu retrospektif olarak degerlendirildi. En kg 2 ve en byg ise 70 yasindaydi. Trafik kazasi en sik travmatik nedendi. Izlem sirasinda 2 hastada tansiyon pnmosefalus gelisti. Sonu olarak bu alismada kaide kirigi komplikasyonlarindan olan posttravmatik intrakranial enfeksiyon ve tansiyon pnmosefalusun nemi vurgulandi.
Typieally, these fraetures involve the perinasal sinuses and mastoid air eells Basal skull fraetures are divided into two subgroups. Fractures that traverse the petrous pyramid at right angles are ealled "transverse fraetures," and hematotympanum is a eommon finding in these cases. These fraetures often spare the nerves but disrupt the ossieular ehain Basal skull fraetures can result in injury to eranial nerves and arteries Olfaetory nerve injury often oecurs with anterior fossa basis fraetures, and results in anosmia.
Injury to CN VI can oeeur with fraetures of the eliyus Basal skull fraetures are associated with traumatie earotid-eavernous fistulae, traumatie aneurysms of the petrous and eavernous portions of the earotid artery, and earotid artery oeclusion 0,18,21, Cerebrospinal fluid CSF fistula is the most important eomplieation associated with basa skull fraetures.
These fistulae are classified in two major groups, as traumatie and nontraumatie CSF fistulae may be deteeted either in the first week after the trauma aeute , or after months, and even years, posttrauma delayed.
This life-threatening complieation was first described by Bidloo and Elder in the 17th century Miller identified nontraumatie rhinorrhea in , and proved that this eondition oeeurs as a result of increased CSF pressure In , Chiari was able to demonstrate a postmortem fistula between the ethmoid sinuses and a pneumatoeele of the frontal lobe in a patient who had had meningitis with rhinorrhea Another important eomplieation, espeeially of traverse of paranasal mastoid fraeture, is pneumoeephalus.
In addition to head trauma, other eauses of pneumoeephalus include infeetion, tumor, eongenital eranial defect, shunt plaeement, and the use of nitrous oxide during anesthesia 3,4,7,20,24, Especially in the past 20 years, our ability to diagnose and treat basal skull fraetures and CSF fistulae has improved with the advent of new teehniques. The leakage site can now be easily. CT eisternography with metrizamide is the best diagnostie method 13, From November to Deeember , head trauma patients were treated in our department.
The ages of these patients ranged from 2 to 70 years, and the mean age was The eauses of trauma were traffie aeeident 28 patients , falIing 11 patients , and blow to the head 1 patient Table Nineteen of the patients had otorrhea and five had rhinorrhea.
Craniography and eranial CT were routinely performed on all of the patients. In addition, eranial CT led to diagnoses of pneumoeephalus in 10 patients, brain eontusions in 7, brain edema in 2, and aeute subdural hematoma in one patient.
Medical therapy included the following: 1 elevation of the head, 2 prevention of increases in intraeranial pressure use of eough preventatives, laxatives, sedatives , 3 eontinued lumbar CSF drainage, 4 drugs to reduee CSF produetion dexamethasone, aeetazolamide, furosemide , 5 prophylaetie antibioties eephtriaxon and ornidazole , and 6 use of antiepilepties.
In all of the patients who had otorrhea and who reeeived medical treatment, CSF leakage stopped within 1 week. The same was true for all but one patient with rhinorrhea, whose CSF.
Table i. Number of cases of head trauma by age group. Causes of head trauma. Table III. Glasgow Coma Scale scores for the 40 patients. Four patients underwent surgical treatment. Surgery was indicated when there was rapid deterioration in a patient's level of consciousness and a worsening prognosis. In two patients, cranial CT demonstrated tension pneumocephalus, which required emergency surgical treatment.
In one of these patients GCS 7 , the air was released through a drilled burr hole. The other patient underwent craniotomy and duraplasty.
A third individual had rhinorrhea that continued for over 2 weeks, and this patient was treated with duraplasty. The fourth patient's cranial CT revealed an acute subdural hematoma, and this required drainage via craniotomy. Three of the 40 basal skull fracture of patients developed posttraumatic meningitis.
One of these individuals had been hospitalized for 3 days at another facility due to trauma, and his level of consciousness deteriorated 2 days after discharge. The patient died 1 hour af ter admittance to our emergency elinic. There were no signs of pathology on the patient's cranial CT.
His CSF was eloudy, and. Another patient, who had a traumatic corneallaceration, was treated at the ophthalmology elinic. When fever, signs of meningeal irritation, and diminished consciousness developed, this patient was diagnosed with posttraumatic meningitis. Third patient who received prophylactic antibiotics developed meningitis. The hospitalization period for our patients ranged from 3 to 29 days mean, 8 days.
One patient died due to disseminated pneumocephalus and brain contusions. Another developed subarachnoidal hemorrhage and exophthalmos. In this patient, digital subtraction angiography revealed a carotidcavernous fistula. Of head trauma patients admitted to our elinic, 40 had basal skull fractures and 24 of those with basa skull fractures had CSF fistulae.
These proportions correspond fairly well with those reported in the literature. Basal skull fractures and traumatic CSF fistulae are less common in children than in adults This is due to the child's immature growth of the frontal sinuses, the presence of a cartilaginous-type ethmoid bone, and the more elastic basis cranii than adults', all of which result in better absorption of head trauma. Ninety-seven percent of our patients with skull fractures and fistulae had been injured in one of these two ways.
The detection of otorrhea and rhinorrhea is very important with regard to diagnosing CSF fistula and. Following cranial trauma, fluid leakage from the nose and ear is assumed to be CSF when blood is visualized centrally, surrounded by clear fluid. The best and most recent method for identifying the origin of the leaked material is the detection of b2 transferrin through immunoelectrophoresis Concerning the diagnosis of CSF fistulae, various techniques have been used to date, including direct craniography, intrathecal injection of different dyes, and pneumoencephalography.
The introduction of CT has made it very easy to detect basal skull fractures and associated with CSF fistulae. In particular, thinslice axial and coronal scanning allows accurate diagnosis and pinpointing of the anatomicallocation of the fistula and the fracture 2, In , Drayer 13 and Manelfa 19 reported that metrizamide cranial CT-cisternography was the best technique for locating a CSF fistula.
Recently, new techniques, including MR! Currently, metrizamide cranial CT-cisternography remains the best way to diagnose these fistulae. Craniography and cranial CT were done routinely on all of our patients.
In addition, cranial CT revealed that 10 patients had pneumocephalus, 7 had brain contusions, 2 had brain edema, and 1 had an acute subdural hematoma. One important complication of basal skull fracture is tension pneumocephalus, a problem that may require immediate surgery 7,20, Research has shown that patients with rhinorrhea and otorrhea are at greater risk of developing tension pneumocephalus compared to other head trauma patients In these patients, an increase in nasopharyngeal pressure causes air to enter the cranial cavity through the dural defect and then become trapped.
Elevated intracranial pressure may increase the size of the defect and the patient's condition may deteriorate due to the pressure exerted on the brain and the air accumulating inside the cranium. The treatment for one GCS 7 involved releasing the air through a burr ho le, and for the other involved craniotomy and duraplasty. CSF leakage stopped after 1 week in all of our patients who had otorrhea and was treated medically.
The same was true for all but one patient with rhinorrhea, whose CSF leakage continued for more than 2 weeks and required surgical treatment. Meningitis is the most important problem associated with CSF fistulae, and causes high morbidity and mortality, even when antibiotic therapy is used. There is controversy regarding the use of prophylactic antibiotics in patients with CSF fistula and basal skull fracture 6,14, Some reports have stated that such treatment does not effectively reduce the risk of meningitis in patients with traumatic CSF fistulae 5,14,17, Choi et aL.
In contrast, Brodie 7 investigated cases of posttraumatic CSF fistula, and found a lower incidence of meningitis in those who received prophylactic antibiotic therapy than in those who did not use preventive antibiotics. Of all our patients with basal skull fractures and CSF fistulae who were given antibiotic therapy, onlyone developed meningitis. On the other hand, two of the patients who were not given prophylactic antibiotics developed this infection.
Suspek Fraktur Basis Cranii
Head injury is the leading cause of death, and disability. Benefits of the head, including skull and face is to protect the brain against injury. In addition to coverage by the bone, brain, also closed a hard layer called the meninges fibrous and there is a liquid called cerebrospinal fuild CSF. Trauma has the potential to cause skull fractures, bleeding in the space surrounding the brain, bruises on the brain tissue, or nerve damage relations between the brain 1. Patients with Basilar skull fracture pertrous os temporal fracture was found with otorrhea and a bruise on the mastoids battle sign. Presentations with anterior fossa fracture cranii base is Rhinorrhea and bruising around the palpebra Raccoon eyes.
Fraktur Basis Cranii
Abstract: Fractures of the basis cranii are usually the result of extension of a vault fracture. The most important complications associated with these fractures are cerebrospinal fluid CSF fistula, related infection, and pneumocephalus with fistula. CSF fistula involves the leakage of fluid from the subarachnoid space to the extraarachnoidal space through a defect in the arachnoidea, the dura, or the epithelial tissue. Although this leakage can occur along the cerebrospinal axis, it most often appears clinically as otorrhea and rhinorrhea. Meningitis is the most important complication of CSF fistulae. We retrospectively studied 40 basis cranii fracture cases that were treated at our clink between November and December The most common cause of the fractures was traffic accident.
Askep Fraktur basis cranii
PendahuluanFokus pembicaraan : penanganan awal pasien CK sebelum dirujukMasalah pada kasus iniTujuan presentasi ini :Mendiskusikan penatalaksanaan pada pasien cedera kepala pada kondisi di UGD, kriteria merujuk pasien, indikasi merawat inap. Kemampuan untuk merotasikan leher sebesar 45 derajat ke kanan dan ke kiri merupakan metode efektif untuk mengeksklusi adanya cedera cervcial yang signifikanGuideline on the management of alert, adult patients with potential cervical spine injury in the Emergency Department. London TataLaksanaTidak menunjukkan perbedaan signifikan dalam mengurangi risiko meningitis bakterial pada kasus fraktur basis kranialAntibiotik yang dipilih berdasarkan flora normal daerah nasofaringeal sebagai sumber infeksi. Clin Infec Dis ; 27 : 9. Pemberian RanitidinTataLaksanaPemberian ondansetron untuk muntah pada pasien cedera kepala yang tidak dilakukan CT scan tidak meningkatkan risiko misdiagnosis akibat efek masking terhadap cedera yang serius. Pemberian OndansetronSturm JJ, et al. Pemberian PiracetamZavadenko NN et al.