De Tommasi Antonio, Cascardi Pasquale, De Tommasi Claudio, Luzzi Sabino, Ciappetta Pasqualino
Department of Neurology and Psychiatry Sciences, University of Bari, 70124 Bari, Italy.
World J Emerg Surg. 2006 Dec 14;1:36. doi: 10.1186/1749-7922-1-36.
Very few cases of severe penetrating injuries to the skull base with a seemingly innocuous object have been described in the literature. Of the cases reported, only ten involve a penetrating screwdriver. However, the choice of therapeutic management, whether it be emergency surgical or non-surgical removal of the penetrating object as well as the selected surgical approach remain quite controversial.
The authors describe the case of a severe penetrating skull base injury caused by a screwdriver, following an accidental fall from a ladder. The patient was admitted in Glasgow Coma Scale (GCS) 11 with a cerebrospinal fluid (CSF) leak in the right maxillary area. The tri-dimensional computerized tomography (3-D CT) scan revealed an oblique trajectory of the screwdriver shank through the skull base. The authors opted for an emergency surgical extraction of the object. A contra-lateral pterional approach was successfully performed and a two-year follow-up showed no neurological deficits.
The reported case supports the choice of emergency surgical removal of the object in penetrating skull base injuries involving the anterior skull base with neurovascular lesions. Surgical aspects of the pterional approach, and in particular the left pterional approach as well as other cranio-facial approaches in severe penetrating skull base injuries are discussed.
文献中报道的因看似无害的物体导致严重颅底穿透伤的病例极少。在已报道的病例中，仅有10例涉及螺丝刀穿透伤。然而，对于治疗方法的选择，无论是紧急手术取出还是非手术取出穿透物体，以及所选的手术入路，仍然存在很大争议。
作者描述了一例因从梯子上意外跌落导致螺丝刀造成严重颅底穿透伤的病例。患者入院时格拉斯哥昏迷量表（GCS）评分为11分，右侧上颌区域有脑脊液（CSF）漏。三维计算机断层扫描（3-D CT）显示螺丝刀柄通过颅底的斜行轨迹。作者选择紧急手术取出物体。成功实施了对侧翼点入路，两年随访显示无神经功能缺损。
该报道病例支持在涉及前颅底且伴有神经血管损伤的颅底穿透伤中选择紧急手术取出物体的做法。文中讨论了翼点入路的手术要点，特别是左侧翼点入路以及严重颅底穿透伤中的其他颅面入路。
