A fracture of the base of the skull is one of the most severe traumatic brain injuries. This condition is accompanied by damage to one or even several bones that form the base of the skull. Damaged in this case may be:
- occipital bone;
- temporal bone;
- ethmoid bone;
- sphenoid bone.
A fracture of the base of the skull can occur from a variety of serious physical injuries: car accidents;
- when a person falls from a great height;
- when hitting the face in the area of the lower jaw or base of the nose.
In most patients, the base fracture occurs from the arch. Statistics say that the number of such patients reaches 59%.
Symptoms of a basal skull fracture
A fracture of the base of the skull is an open traumatic brain injury. It is worth noting that injuries accompanied by the release of blood or cerebrospinal fluid from the ear canals or nose are classified as open penetrating head injuries.
Based on location, injuries are divided into fractures:
- middle cranial fossa;
- anterior cranial fossa;
- posterior cranial fossa;
The most common fractures encountered in medical practice are middle cranial fossa fractures. Such fractures can be longitudinal, transverse or oblique. Most often, doctors fix longitudinal fissures in the temporal lobes. In this case, fractures can spread through various holes, crevices and thinning of the skull bones.
Among the main manifestations of fractures:
- bleeding from the ear canal;
- decreased hearing acuity;
- release of cerebrospinal fluid;
- the appearance of bruises in the area of the temporal muscle.
All of the above damage occurs when there is a blow to the occipital region.
It is worth noting that transverse fractures are clinically characterized by the patient being completely deaf. The patient may also exhibit disturbances in vestibular function, loss of taste in the two anterior thirds of the tongue, and may also experience peripheral facial palsy.
Fracture of the skull (Fracture of the skull bones)
First aid
All patients with traumatic brain injury must be immediately transported to the hospital.
At the first aid stage, the patient is placed in a horizontal position. If the victim is conscious, he is placed on his back. Unconscious patients are placed in a half-turn position. To create this position, you can place small pillows or outerwear under your back on one side. The patient's head is turned to the side so that when vomiting he does not choke on the vomit. Create peace for the head using available means: clothes, pillows or bolsters. Stop the bleeding by applying a pressure bandage to the wound. Cold is applied to the injury site. The patency of the airways is checked, if necessary, the retraction of the tongue is eliminated, the airways are cleared of vomit, etc. Analeptics (cytisine, nicotinic acid diethylamide) and cardiac glycosides are administered according to indications.
Conservative therapy
At the hospital stage, treatment of skull fractures is often conservative; operations are performed according to strict indications. Conservative therapy is prescribed to patients with fractures of the base of the skull, closed fractures of the calvarium, subarachnoid hemorrhages, concussion and contusion of the brain. All patients are prescribed bed rest, the duration of which depends on the severity of the injury, and hypothermia of the head (ice packs are used). Dehydration therapy is carried out, antibiotics and painkillers are prescribed. For fractures of the base of the skull, repeated lumbar punctures are performed or a lumbar drain is applied.
Treatment tactics in each specific case are determined by the severity and characteristics of the traumatic brain injury. Thus, for concussions, patients are prescribed vasotropic and nootropic drugs. For brain contusions, the range of therapeutic measures expands and includes not only means for improving cerebral blood flow and energy supply to the brain, but also metabolic and anti-inflammatory therapy, etc. During the recovery period, nootropic drugs and drugs are used to improve cerebral microcirculation (cinnarizine, vinpocetine ).
Surgery
Surgical treatment may be required for severe skull fractures, especially depressed ones. Trepanation is performed under general anesthesia, during which the doctor creates a hole in the skull and removes embedded fragments, foreign bodies and destroyed tissue from the brain. The formation of intracranial hematomas in the vast majority of cases is an indication for urgent surgery, during which the surgeon removes accumulated blood, rinses the cavity, and identifies and eliminates the source of bleeding.
Indications for surgical intervention for fractures of the base of the skull in the acute period may be damage to the facial or optic nerve, and in the long-term period, continued leakage of cerebrospinal fluid from the ear canals or nasal passages. The prognosis for skull fractures depends on the severity of the traumatic brain injury. Both complete recovery and severe consequences that cause the patient’s disability are possible.
Consequences of skull base fractures and prognosis
Experts note that the future quality of life of patients directly depends on the quality of rehabilitation after TBI, as well as on the nature of this injury, pathologies and possible infections. In the absence of purulent inflammation, in most cases, doctors give a favorable prognosis.
If there are infectious complications, doctors talk about the possibility of developing complications such as encephalopathy, frequent headaches, uncontrolled increase in blood pressure, etc. in the future. This condition may also be accompanied by recurrent epileptic seizures.
Some traumatic brain injuries can cause excessive bleeding, coma, and even death. With such injuries, the prognosis of doctors is extremely unfavorable.
Bleeding of small volumes, intracerebral hematomas, etc. can form. It is worth noting that in this situation, the patient’s future directly depends on the timeliness and adequacy of the treatment.
Traumatic brain injury. Depressed skull fracture
Etiopathogenesis
In this case, there is apparently no particular point in analyzing the reasons in detail (which is included in the concept of “etiopathogenesis” along with the mechanisms and patterns of development of the disease): any mentally healthy person understands that the head must be protected and protected above all else, and observe all precautions and technical rules safety, use protective equipment, fall only on your side (never on your back), etc.
In addition, the main groups of reasons have already been given above. As for the mechanisms of occurrence of skull fractures, they are quite complex and, even if it sounds tautological, are associated primarily with the mechanics, kinetics and dynamics of the traumatic impact. A depressed fracture, by definition, is a violation of the natural integrity and shape of the skull: some area of it is crushed by impact or inward pressure. There are three main types of such a fracture:
- impression (the surface of the skull remains relatively continuous; the injured area retains connection with the intact vault, but is dented by the impact force like a cone- or cup-shaped crater);
- depression (completely broken off bone fragments are formed, which are located below the surface of the main vault, i.e. in the internal space of the cranium);
- expressional (not mentioned in many sources, but in practice it actually occurs as a separate option: bone fragments are turned at some angle to the surface of the skull and partially protrude outward above its level).
With a trauma of such intensity that it could cause a depressed fracture, not only bone structures are always damaged, but also the substance of the brain. In the best case, a severe contusion (bruise, usually with hemorrhage and hematoma) occurs without rupture of the meninges - if they remain intact, it is more often in young victims, since the degree of elasticity and strength of the tissues significantly depends on age.
The nature of the deforming bone destruction also to some extent depends on the biochemical composition of the bones, their strength and thickness at the point of impact - which, in turn, can occur either in the middle of one of the 23 bones of the skull, or at the joint between them, which with the same force will lead to different consequences. The main factors are the vectors of applied forces and reactive internal stresses. The closer to the normal (right angle, perpendicular at a given point of the surface) the angle of impact or pressure, the more powerful the destructive effect - it is intuitively clear that a tangential impact is less dangerous. With equal force, the smaller the contact area, the higher the local pressure - this is an elementary physical law that makes pointed objects much more dangerous than blunt ones. The greater the impulse (the established “quantity of motion”, i.e. the product of the mass of a moving body and its speed), the more powerful the blow. When falling from a height or other accelerated movement, which is stopped in a split second by a stationary or moving obstacle, the physical pathogenesis is somewhat different from that of a blow to a stationary head: not only a “break” of the bone occurs, but also a much more dangerous (often fatal) inertial displacement of the brain inside the cranium with an additional impact on the inner surface of the skull.
Often, a depressed fracture is accompanied by a linear, stellate or “web” fracture. Extremely dangerous, other things being equal, is polytrauma, i.e. simultaneous (with a depressed skull fracture) traumatic damage to several other key organs: the prognosis in this case is statistically very bad, since the severity of each injury, so to speak, is not summed up, but multiplied, that is, the consequences mutually potentiate each other.
Data on mortality vary greatly depending on the source, region of study and the formulation of the statistical and analytical problem. However, it is known that 40-60% of patients with open traumatic brain injury die before reaching an emergency care facility.
Another fact is also reliably known: car belts and airbags, the presence on the head of a protective helmet, a helmet or simply a thick (for example, fur) headdress - not to mention the elementary caution dictated by the instinct of self-preservation and the title "sapiens" - in many cases really save lives. In the most literal sense.
Treatment of depressed skull fractures in CELT
A depressed skull fracture is an indication for neurosurgical surgery. All of them are characterized by technical complexity, require special skill and practical experience from the neurosurgeon, and last more than one hour. First of all, they are aimed at eliminating compression of the medulla. The process involves removing or moving bone fragments and examining the membranes and substance of the brain. If there are indications, identified hematomas and dead tissue are removed, plastic surgery of skull defects caused by a fracture is carried out. The volume of bone removal, access option and urgency of the operation are determined individually, based on the nature of the injury and the severity of the patient’s condition.
If, during neurosurgical intervention, damage to the dura mater is detected, the doctor examines the space under it, removes hematomas and crush areas. After this, he injects antibiotics into the wound. The damaged areas of the dura mater are removed, and the dura mater itself is sutured or plastic surgery is performed using implants from the victim’s tissue or in the form of a Teflon membrane. Plastic surgery is especially justified because it eliminates the formation of rough scars and the penetration of postoperative liquorrhea.
The Department of Neurology at CELT employs neurologists and neurosurgeons with many years of experience in scientific and practical work. They have everything necessary to determine all the features of a fracture and properly treat it. You can make an appointment with them online on our website or by contacting our operators: +7 (495) 788 33 88.
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