Clinical and Radiological Study of Patients With Skull Base Fracture After Head Injury

Traumatic brain injury (TBI) is the largest contributor to morbidity and mortality in various parts of the world. Skull base fracture (SBF) is one of the many manifestations that can occur in cases of mild to severe TBI. With varying patterns of TBI, it was necessary to review the characteristics of SBF, clinical manifestations, cerebrospinal fluid leakage, and complications. The data were taken from the medical records of SBF patients who were treated at RSUD (Regional Public Hospital) Dr. Soetomo in the period January 2014 - July 2019. Then, the data obtained were written on the collection sheet and analyzed descriptively using RKward. It was found that SBF most often occurs due to severe TBI (60.14%). 77.7% of SBF patients were male and 35.1% of all patients aged 15-24 years. The most frequent cause was traffic accidents (86.5%). The anterior cranial fossa (ACF) was the most frequently fractured part of the skull base (30.4%). There was a significant relationship between the severity of TBI with the occurrence of CSF leakage and complications. About 33 patients (22.3%) had complications such as pneumocephalus and 9 patients (6.1%) had meningitis. Complications in the form of brain abscess and hydrocephalus in 1 (0.7%) patient each. SBF often occurred in men of productive age 15-24 years. The ACF was the most frequently fractured part. The majority were caused by traffic accidents accompanied by severe brain injuries. The most common complications were pneumocephalus, meningitis, brain abscess, and hydrocephalus.

Klasifikasi Patah Tulang Dasar Kepala

Skull base fracture is a linear fracture that commonly occurs in the temporal cranium. Traumatic brain injury (TBI) often found and handled in the emergency department is head trauma and traffic accident is the main cause of base skull fracture. Approximately 25%-66% of traffic accidents cause fracture of the skull base according to the fracture site. This study was aimed to obtain the classification of skull base fractures and the most common types of classification. This was a literature review study using three databases, namely Google Scholar, ClinicalKey, and PubMed. Based on the inclusion and exclusion criteria, there were 14 literatures reviewed consisting of 1 retrospective study, 2 clinical reviews, 1 literature review, 3 review articles, 2 prospective studies, 3 case reports, 1 descriptive study, and 1 case study. These articles reviewed the classification of skull base fracture. The classification of each section was arranged based on the mechanism and location of skull base fractures. In conclusion, the classification of skull base fracture is divided into anterior, middle and posterior fossa cranii fractures. Fractures of the middle cranii fossa is the most common case and of the posterior cranii fossa is the rarest case.Keywords: traumatic brain injury (TBI); skull base fractures; fracture classification Abstrak: Patah tulang dasar kepala merupakan jenis fraktur linier yang umum terjadi pada bagian temporal kranium. Kasus trauma yang sering ditemukan dan ditangani di unit gawat darurat ialah trauma kepala. Kecelakaan lalu lintas (KLL) merupakan penyebab utama fraktur basis kranii. Sekitar 25-66% kasus KLL menyebabkan kejadian fraktur basis kranii sesuai lokasi fraktur. Penelitian ini bertujuan untuk mengetahui jenis klasifikasi patah tulang dasar kepala dan jenis klasifikasi yang paling sering terjadi. Jenis penelitian ialah suatu literature review. Literatur diperoleh dengan menggunakan beberapa database, seperti Google Scholar, ClinicalKey, dan PubMed. Berdasarkan kriteria inklusi dan eksklusi didapatkan 14 literatur terdiri atas 1 retrospective study, 2 clinical review, 1 literature review, 3 review article, 2 prospective study, 3 case report, 1 descriptive study, dan 1 case study. Hasil penelitian mendapatkan 14 literatur mengulas tentang klasifikasi patah tulang dasar kepala dan klasifikasi setiap bagian disusun berdasarkan mekanisme fraktur dan lokasi fraktur yang terjadi. Simpulan penelitian ini ialah secara garis besar klasifikasi patah tulang dasar kepala terbagi atas fraktur fossa kranii anterior, media, dan posterior. Kasus fraktur fossa kranii media merupakan kasus yang paling sering terjadi dan kasus fraktur fossa kranii posterior merupakan kasus yang paling jarang terjadi.Kata kunci: trauma kepala; patah tulang dasar kepala; klasifikasi fraktur

Pneumocephalus and CSF leak secondary to skull base fracture by pyrotechnical object: case report

Introduction: Pneumocephalus is mainly associated with traumatic injuries, being a rare complication but with high mortality rates; it behaves like a space-occupying lesion and increases intracranial pressure. The symptoms are not specific, but in the event of trauma it is necessary to suspect this entity to carry out a timely diagnosis and treatment, since being the product of the skull base fracture it can cause communication with the outside, and the appearance of cerebrospinal fluid (CSF) leak. Clinical Case: a 38-year-old male patient who suffers trauma from a pyrotechnic explosion near his right ear, when handling a pyrotechnic object (whistle) during the New Year, presenting severe pain, slight bleeding in the right ear, feeling faint and holocranial headache that increased in a standing position; likewise, he presents high-flow aqueous secretion (CSF) from the right ear. Brain and skull base tomography (CT) showed air in the intracranial cavity, fracture of the skull base, and the ossicles of the right middle ear. Conservative management was performed using rest and lumbar drainage, presenting a satisfactory evolution. Conclusion: Pneumocephalus is a frequent and expected complication of trauma with a skull base fracture. Its early and timely diagnosis using skull base CT is essential to define therapeutic measures. Accidents due to the misuse of pyrotechnics continue to be a relevant problem in our country. Knowing and disseminating its consequences can help raise awareness in the population. Keywords: Pneumocephalus, Skull Base, Intracranial Pressure, Cerebrospinal Fluid Leak. (Source: MeSH NLM)

Isolated Unilateral Vocal Fold Palsy following Skull Base Fracture: A Case Report

Isolated lower cranial nerve (CN) palsy affecting the CN X resulting from a skull base fracture is very rare. The clinical manifestation and natural history is related closely to the complex anatomy of this region and mechanism of injury. Here, we report a case of a 54 year-old man who presented with a delayed onset of dysphonia and dysphagia with aspiration following a closed head injury sustained from a motor vehicle accident. Injection laryngoplasty was implemented to alleviate symptoms of his CN X palsy, which eventually almost completely resolved. High index of suspicion should be maintained when investigating possible skull base fractures, especially with a suggestive clinical presentation of lower CN palsies affecting one or all the lower CNs. Delayed onset of these CN palsies are likely to have more favourable outcomes.