[Early and late complications of craniocerebral trauma. Chronic subdural hematoma/hygroma, carotid-cavernous sinus fistula, abscess formation, meningitis and hydrocephalus].

A group of 318 patients suffering from severe head injury, 51 of whom died of their (head) injury, is reviewed. A small contusional cerebral haemorrhage had occurred in 50.6%, and 30% had had basal skull fractures. In the entire group, 2.8% developed posttraumatic hydrocephalus. Shunt implantation was necessary between the 11th and 123rd posttraumatic days (mean 52nd). All patients with inflammatory problems, e.g. meningitis or intracranial abscess, developed posttraumatic hydrocephalus. In 10 of the 12 patients with hygromas, an operative procedure with bur hole trepanation was necessary. Half of the patients with hygromas were polytraumatized but only 25.85% of the entire group. Two patients in the group and a further 49 patients with chronic subdural haematomas were operated on by a bur hole trepanation and appropriate drainage for several days. In 2 cases the development of the chronic subdural haematoma had been documented by CAI. All patients with frontobasal skull fractures were operated on by a transethmoidal approach only the 1st day. Only 2 of the laterobasal skull fractures needed an operation. One of these caused was by a pneumocephalus. In 0.9% of the patients an intracranial abscess was present; these all had a basal skull fracture, 1 after gunshot injury. Among the patients with basal skull fractures 3.1% developed carotid artery-cavernous sinus fistula. One of these three fistulas has been documented as yielding to spontaneous closure. After reangiography for balloon occlusion an aneurysm was found. Following primary operation, 2.5% of patients required revision operation because of renewed bleeding. The posttraumatic treatment of the complications is discussed.