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Applied skull base anatomy is reviewed in Appendix E1. Surgical approaches to the skull base are shown in Figure 1. In this article, CT features and classification systems are presented in relation to clinical decision making and management principles using the framework of frontobasal, laterobasal, posterior basal, and basioccipital (central clival) skull base fractures ( 10, 11). Improved survival in head-injured patients increases emphasis on skull base fracture management ( 1).Ī range of complications is encountered, including cerebrospinal fluid (CSF) leak, encephalocele, meningitis, orbital apex syndromes (OASs), facial nerve paralysis, hearing loss, and cholesteatoma ( 8, 9). Common causes of skull base fracture include traffic accidents, falls, assaults, and gunshot wounds ( 6, 7). The temporal bone is involved in approximately 40% of patients, the orbital roof in 24%, the sphenoid bone in 23%, the occipital bone in 15%, and the ethmoid bone in 11% ( 5). Skull base fractures occur in 4%–30% of patients admitted with head injuries ( 1– 4).
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Online supplemental material is available for this article. The radiologist should be able to envision stepping into a multidisciplinary planning discussion and engaging neurotologists, neuro-ophthalmologists, neurosurgeons, neurointerventionalists, and facial reconstructive surgeons to help synthesize an optimal management plan after reviewing the skull base CT findings at hand. Additional imaging is warranted to clarify ambiguity (particularly for potential sources of CSF leak) in other cases, clinical and CT criteria alone are sufficient to determine the need for intervention and the choice of surgical approach. The radiologist should leverage understanding of specific strengths and limitations of CT to anticipate next steps in the skull base fracture management plan. CT provides prognostic information about short- and long-term risk of cerebrospinal fluid (CSF) leak, encephalocele, meningitis, facial nerve paralysis, hearing and vision loss, cholesteatoma, vascular injuries, and various cranial nerve palsies and syndromes. CT often plays a complementary, supportive, or confirmatory role in management of skull base fractures in conjunction with results of physical examination, laboratory testing, and neurosensory evaluation. Laterobasal, frontobasal, and posterior basal fracture patterns are emphasized. The authors aim to provide a pragmatic overview of CT for skull base fractures within the broader context of diagnostic and treatment planning algorithms. Successfully parlaying knowledge of skull base anatomy and fracture patterns into precise actionable clinical recommendations is a challenging task. Neurological surgery 2 (1973), 969–977.As advances in prehospital and early hospital care improve survival of the head-injured patient, radiologists are increasingly charged with understanding the myriad skull base fracture management implications conferred by CT. R., Skull fracture and management of open head injury. A., One stage debridement and plastic repair of compound comminuted depressed skull fractures with methylmethacrylate. Oh, S., Rüedi, M., Depressed skull fracture in skiing and their experimental study. Oh, S., Die Verhütung der Kopfverletzungen beim Skifahren. P-26, New York: Society of automotive engineers Inc. Proceedings of 12 stapp car coach conference. W., Danforth, J., Impact tolerance of the skull and face. T., Straticulate decompression of depressed skull fractures. Lippert, H., Käfer, H., Dicken der Knochenschichten. Kröger, M., Marin, K., Zur Problematik der Versorgung offener Impressionsfrakturen der Schädelkalotte. Knoringer, P., Sofortdeckung von Schädellücken bei offenen und geschlossenen Impressionsfrakturen des Hirnschädels mit Acrylharzkunststoff (ein klinischer Vergleich zwischen Palos K und Refobacin-Palacos R). M., Experimental skull deformation and brain displacement demonstrated by flash X-ray technique. M., Significance of relative movements of scalp, skull and intracranial contents during impact injury of the head. Al Zain, T., et al., Zur Diagnostik und Therapie der Schädelkalottenimpressionsfrakturen.