Sandner A, Kern C B, Bloching M B
Klinik für Hals-Nasen-Ohrenheilkunde und Kopf-Hals-Chirurgie der Martin-Luther-Universität Halle-Wittenberg.
Laryngorhinootologie. 2006 Apr;85(4):265-71. doi: 10.1055/s-2005-921056. Epub 2006 Feb 21.
Surgical management of multiple traumatized patients with head and neck trauma is highly individualized and depends on a number of factors including etiology, intracranial pressure, concomitant injuries, patient age and the possibility of an interdisciplinary procedure. Severe head and neck trauma are often connected with fractures of the frontal skull base or nasoethmoido-orbital complex and CSF leakage. If there is suspicion of a CSF leakage surgical management to cover the dura-defect is essential. An intradural approach is necessary in case of concomitant intradural injuries while primary extradural access provides excellent exposure of the rhinobasis with low morbidity and good results.
We report about our surgical experiences of 55 patients with severe frontobasal trauma, who were operated between 1/1999 and 11/2003. The subfrontal approach according to Raveh we had chosen in 20 patients which were operated by an interdisciplinary team together with the neurosurgeons. With an average follow up of 36 month we report about early and late complications.
19/20 patients showed sufficient coverage of the CSF leakage, once a revision surgery was necessary. Finally this patient had also an unobjectionable coverage of the CSF leakage. We saw no major complication like meningitis or brain abscess, intracerebral haematoma or surgical injury of the orbital wall. The most important complication was an anosmia, which depending on the extension of the approach results in any patients.
Our results show that the subfrontal approach is a reliable method to explore extensive frontal dural defects and to reconstruct fractures of the frontal skull base without additional trauma to the frontal lobe.
伴有头颈部创伤的多发伤患者的手术治疗高度个体化，取决于多种因素，包括病因、颅内压、合并伤、患者年龄以及多学科联合手术的可能性。严重的头颈部创伤常与额颅底骨折或鼻筛眶复合体骨折及脑脊液漏相关。如果怀疑存在脑脊液漏，手术修复硬脑膜缺损至关重要。伴有硬脑膜内损伤时需要采用硬脑膜内入路，而初次采用硬脑膜外入路可很好地显露鼻底部，且发病率低、效果良好。
我们报告了1999年1月至2003年11月期间接受手术的55例严重额颅底创伤患者的手术经验。我们对20例患者采用了Raveh的额下入路，这些患者由多学科团队与神经外科医生共同手术。平均随访36个月，我们报告了早期和晚期并发症情况。
20例患者中有19例脑脊液漏得到充分覆盖，有1例需要进行翻修手术。最终该患者的脑脊液漏也得到了满意的覆盖。我们未观察到如脑膜炎、脑脓肿、脑内血肿或眶壁手术损伤等严重并发症。最重要的并发症是嗅觉丧失，根据手术入路范围不同，部分患者出现该并发症。
我们的结果表明，额下入路是一种可靠的方法，可用于探查广泛的额部硬脑膜缺损并重建额颅底骨折，且不会对额叶造成额外创伤。
