Fracture of the base of the skull bones

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Treatment of a skull fracture

For accurate and detailed diagnosis of trauma, a method of magnetic resonance imaging (MRI) or computed tomography (CT) is used. Depending on the severity and complexity of the damage, treatment can be conservative or operative.

Conservative treatment

Conservative methods are indicated for minor and moderate injuries, when it is possible to eliminate liquorrhea by a non-surgical route.

Strict bed rest should be observed, the head should be in an elevated position – this helps to reduce the allocation of cerebrospinal fluid. Treatment includes dehydration therapy (aimed at reducing the fluid content in the organs), for this purpose, lumbar punctures are performed every 2-3 days (taking of cerebrospinal fluid from the spinal cord at the level of the waist), subarachnoid insufflation (introduction into the subarachnoid space of the spinal cord) of the same amount of oxygen. Also drugs used to reduce the production of cerebrospinal fluid are diacetics diuretics, lasix.

Physical loads are limited to six months. The victim should be registered with a traumatologist and neurologist, observed with an otolaryngologist and oculist.

Special attention should be paid to preventing intracranial complications of a purulent nature. To this end, sanation of the nasopharynx, oral cavity and middle ear with the use of antibiotics. In the presence of purulent complications, intramuscular or intravenous injections are supplemented by the introduction of antibiotics into the epidural space (endolumbal). For this, kanamycin, levomycetin, monomycin, polymyxin are used. Endolumbal administration of kanamycin is also performed 2 days after cessation of liquorrhea. It is best to select the drug by sowing flora of cerebrospinal fluid or a smear taken from the nasal mucosa.

Surgical treatment

Surgery is necessary in the following cases:

  • Detecting a multi-fracture fracture;

  • Damage or compression of brain structures;

  • Spreading of cerebrospinal fluid through the nose , which can not be stopped by conservative methods;

  • Recurrences of purulent complications.

It occurs in the presence of bleeding, bruising or bone fragments, which can pose a direct threat to life. In this case, trepanation (opening) of the skull is performed, and after surgery the defect of the bone tissue is closed by a remote bone or a special plate (in most cases). Then follows a long rehabilitation.

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