Correlation between the skull base fracture and the incidence of intracranial hemorrhage in patients with traumatic brain injury

Abstract

PurposeA head injury (HI) may cause a skull fracture, which may or may not be associated with injury to the brain. In essence, a skull base fracture (SBF) is a linear fracture at the base of the skull. Loss of consciousness and Glasgow coma score (GCS) may vary depending on an associated intracranial pathology. The pathomechanism is believed to be caused by high energy impact directly to the mastoid and supraorbital bone or indirectly from the cranial vault. Aim of this study is to define the correlation between SBF and intracranial hemorrhage (ICH) in patients with HI.MethodsAnalysis of data obtained from a retrospective review of medical records and from a systematized database pertaining to diagnostic criteria of SBF patients based only on clinical symptoms associated with ICH caused by HI treated in the Department of Neurosurgery at Dr. Hasan Sadikin Hospital, Bandung, Indonesia from January 1, 2012 to December 31, 2017. The exclusion criteria included age less than 15 years and no head computed tomography (CT) scan examination provided.ResultsA total of 9006 patients were included into this study in which they were divided into 3 groups: group 1, HI with no ICH; group 2, HI with single ICH and group 3, HI with multiple ICH. In all the SBF cases, SBF at anterior fossa accounted for 69.40% of them, which were mostly accompanied with mild HI (64.70%). Severity of HI and site of SBF correlated with the existence of traumatic brain lesions on CT scan, thus these factors were able to predict whether there were traumatic brain lesions or not. Most of the patients with epidural hemorrhage (EDH) has single traumatic lesion on CT scan, whereas most of the patients with cerebral contusion (CC) has multiple traumatic lesions on CT scan. On patients with both traumatic brain injury and SBF, most of the patients with anterior fossa SBF has EDH; whereas most of the patients with middle fossa SBF were accompanied with CC. Surgery was not required for most of the patients with SBF.ConclusionSBFs were strongly correlated with traumatic ICH lesions patients with anterior fossa SBF were more likely to suffer EDH whereas with middle fossa SBF were more likely to suffer CC.

Split hypoglossal facial anastomosis for facial nerve palsy due to skull base fractures: A case report

“…In addition, blunt trauma is accountable for over 90% of all SBF's [ 12 ], with most injuries located in the anterior fossa (51%) [ 13 ]. Faried et al, reported on the occurrence of around 69.4% of cases in the anterior fossa, while 27.5% was in the middle cranial fossa [ 14 ]. Mokolane et al described the center area as the most common target point, and is assumed as the weakest area, due to the presence of neurovascular foramina and thin bones [ 13 , 15 ].…”

Pengaruh Tegangan Tabung terhadap Kualitas Citra pada Pemeriksaan Computed Tomography Kepala menggunakan Iterative Reconstruction

“…Sebagian besar pemeriksaan neurologis memberikan hasil normal, keparahan MHI berhubungan dengan gejala klinis. MHI dapat menyebabkan fraktur, intracranial hemorrhage (ICH), hemorrhagic stroke dan ischemic stroke pada daerah ganglia basalis [11][12][13][14] .Cedera kepala telah dikategorikan : ringan, sedang dan berat sesuai dengan tingkat keparahan oleh Glasgow Outcome Scale (GCS [15]. Selain itu, Cranial malformations dan head congenital menunjukkan pencitraan CT mampu mendeteksi dengan baik [16].…”

Brainstem auditory evoked potential combined with high resolution cranial base CT can optimize the diagnosis of auditory nerve injury

“…Due to the close relationship among tympanum, inner ear, acoustical ossicle and auditory nerve, especially the anatomical location of the middle skull base, hearing impairment is more common in fractures of the middle skull base. 1 Hearing impairment after trauma can be divided into auditory nerve injury and non-neurological injury according to the pathogenesis. The main causes of non-neurological injury include tympanic membrane damage, tympanic effusion and acoustical ossicle fracture, etc.…”