Mohamad Josef
Klinik für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinikum des Saarlandes, Kirrberger Straße 1, 66424, Homburg/Saar, Deutschland.
Radiologe. 2021 Aug;61(8):704-709. doi: 10.1007/s00117-021-00879-3. Epub 2021 Jul 8.
Basilar skull fractures are fractures of the lower part of the skull. They make up about 20% of all skull fractures and are mainly caused by high-velocity blunt trauma and falls from high heights. Depending on their precise location, they can be divided into frontobasal, laterobasal and frontolateral fractures. Possible clinical signs are the presence of cerebrospinal fluid rhinorrhea or otorrhea, periorbital ecchymosis (raccoon eyes), retroauricular ecchymosis (battle sign) and cranial nerve injuries. Furthermore, fractures of the petrous bone can lead to a conductive hearing loss, sensorineural hearing loss as well as dizziness and nausea due to a failure of the labyrinth.
If there are any clinical signs of a basilar skull fracture, neurological deficits or limited consciousness (GCS < 15), a CT should be performed to rule out a basilar skull fracture and accompanying pathologies. In addition, if vascular injury is suspected, a CT angiography should be performed. Treatment is usually interdisciplinary and depends mainly on the accompanying injuries and possible complications. A purely conservative approach with close controls (with imaging) is often sufficient. The surgical approach is primarily used to treat possible complications, for example intracerebral bleeding.
颅底骨折是颅骨下部的骨折。它们约占所有颅骨骨折的20%，主要由高速钝性创伤和高处坠落引起。根据其确切位置，可分为额底骨折、外侧底骨折和额外侧骨折。可能的临床体征包括脑脊液鼻漏或耳漏、眶周瘀斑（熊猫眼）、耳后瘀斑（乳突瘀斑）和脑神经损伤。此外，岩骨骨折可导致传导性听力损失、感音神经性听力损失以及由于迷路功能障碍引起的头晕和恶心。
如果存在颅底骨折任何临床体征、神经功能缺损或意识受限（格拉斯哥昏迷评分<15），应进行CT检查以排除颅底骨折及伴随病变。此外，如果怀疑有血管损伤，应进行CT血管造影。治疗通常是多学科的，主要取决于伴随的损伤和可能的并发症。单纯保守治疗并密切观察（通过影像学检查）通常就足够了。手术方法主要用于治疗可能的并发症，例如脑内出血。
