当院における頭蓋底骨折51例の検討：脳損傷および全身の合併損傷と予後との関係

<p>We analized the 51 cases of skull base fracture who were hospitalized in the acute phase for the past 5 years. The sites of the fractured skull base were anterior cranial fossa in 34 cases, middle cranial fossa in 4 cases, spenoidal bone in 2 cases, petrous bone in 18 cases, and occipital bone in 4 cases totally. The fracture of the facial bone was seen in 13 cases. The systemic injuries were chest injury in 9 cases, abdominal injury in 3 cases, pelvic fracture in 3 cases, and spine fracture in 7 cases. The observed intracranial injuries were acute epidural hematoma in 12 cases, brain contusion in 12 cases, acute subdural hematoma in 9 cases, and traumatic subarachnoid hemorrhage in 6 cases. The pneumocephalus happened in 27 cases and the persistent cerebrospinal fluid rhinorrhea was followed in 6 cases. The neurological symptoms of the cranial nerves were observed in 6 cases and septic meningitis happened in 1 case.</p><p>The prognosis was independent home life in 38 cases, bed-rid­den in 4 cases, vegetative state in 4 cases, and death in 5 cases. The serious head trauma (5 cases), severe chest injury (3 cases) and hemorrhagic shock due to pelvic fracture (1 case) were engaged in the poor prognosis among 9 cases of death or vegetative state. One case of the serious head trauma (5 cases) died of the hemorrhagic shock due to skull base fracture. Two cases became vegetative state following the contusion of the brain stem or cerebellar hemisphere. Among 3 cases of severe chest injury, one case suffered hemorrhagic shock due to hemothorax. Another 2 cases was suffered from respiratory impairment due to bilateral pneumothorax or bilateral lung contusion.</p><p>So the prognosis was analized from the viewpoint of chest injury in 51 cases of skull base fracture. Six cases became vegetative state or death among 9 cases who suffered chest injury such as hemothorax, pneumothorax or lung contusion. However, only 3 cases became vegetative state or death among 42 cases without chest injury. The vegetative state or death was observed significantly more frequently in the cases with chest injury than the cases without chest injury.</p><p>Skull base fracture can cause serious brain damage. Furthermore, associated systematic injuries can cause the circulatory and respiratory failure.</p>