두개기저골 골절 160예에 대한 임상적 고찰 : Clinical Analysis of 160 Cases

정남,조기홍,김한규,조경기 대한신경외과학회 1985 Journal of Korean neurosurgical society Vol.14 No.4

Although the presence of a linear skull fracture involving the cranial vault is very often of no clinical significance, the same is not true of fracture of the base. The authors analyzed 160 cases of basal skull fracture treated in the department of Neurosurgery, presbyterian Medical center from May 1980 to Apr 1985. Clinical features and radiological findings were reviewed, analyzed and correlated each other. The result of the analysis are summarized as follow: 1) The basal skull fractures were more common in man than woman the ratio of 13:3. 2) Clinical features were otorrhea (61.2%), racoon eye (22.5%), and hearing loss (20%) etc in decreasing order. 3) Combined pathologies were skull fracture (45%), subdural hematoma (13.7%), epidural hematoma(11.2%), and pneumocephalus(10%) etc. in decreasing order. 4) The facial nerve, vestibule- cochlear nerve, and olfactory nerve were most common cranial nerves injured. 5) Among the visible fractures in simple X-ray, longitudinal fractures were more common than transverse fractures. 6) CSF leakage were noted in 126 cases, and among them immediate type was far more common (93.6%) than delayed type. 7) Incidence of meningitis was 5%, and most of them were associated with CSF leakage. 8) The infection rate was higher when the CSF leak persisted over 7 days.

외상성 뇌동맥류

김세혁,윤수한,주진양,김동익,최중언,이규창 대한신경외과학회 1993 Journal of Korean neurosurgical society Vol.22 No.12

Five cases of traumatic intracranial aneurysm were presented. All of them were located at the cavernous segment of the internal carotid artery. These lesions were associated with basal skull fracture. Four cases were presented with massive epistaxis, and two of them required transfusion. All cases were treated successfully: four by detachable balloon occlusion of the proximal internal carotid artery and one by trapping of the lesion at the internal carotid artery. Because the mortality rate of ruptured traumatic aneurysm is high, clinical suspicion must be focused on prompt diagnostic work-up and early treatment.

뇌기저부 골절후 발생된 과도한 구인두 출혈의 구인두 전체 신속압박에 의한 응급지혈: 증례보고

모동엽,유재하,최병호,김하랑,이천의,유미현,Mo, Dong-Yub,Yoo, Jae-Ha,Choi, Byung-Ho,Kim, Ha-Rang,Lee, Chun-Ui,Ryu, Mi-Heon 대한악안면성형재건외과학회 2010 Maxillofacial Plastic Reconstructive Surgery Vol.32 No.2

Excessive oral and maxillofacial bleeding causes upper airway obstruction, bronchotracheal & gastric aspiration and hypovolemic shock. Therefore, the rapid & correct bleeding control is very important for life-saving in the medical emergency room. In spite of the bleeding control methods of the wound suture & direct pressure, the postoperative bleeding can be occurred, because of the presence of various bleeding disorders & postoperative delayed wound infections. The proper care of bleeding disorders & wound infections are very important for the control of the delayed postoperative rebleeding. In spite of these methods, active oral bleeding can be presented by the other causes of head injury. A rare but particularly dangerous sort of bleeding that may have an especial importance to the patient with severe basal skull fracture that damage large vessels and even the cavernous sinus. The occurrence of profuse nasal or oropharyngeal bleeding may arise from damage to the anterior and posterior ethmoidal vessels, but when mixed with brain tissue it is evidence of mortal damage. In this condition, rapid entire oropharyngeal packing is essential for the control of active oral bleeding. This is a case report of rapid rational bleeding control method by much amount of wet gauze packings, in a 44-years-old male patient with active oropharyngeal bleeding by basal skull fractures.

Emergency bleeding control by rapid entire oropharyngeal packing in a patient with active oropharyngeal bleeding following basal skull fracture: report of a case (초)

( Oong Yub Mo ),( Jae Ha Yoo ),( Byung Ho Choi ),( Ha Rang Kim ),( Chun Ui Lee ),( Mi Heon Ryu ) 대한악안면성형재건외과학회 2010 Maxillofacial Plastic Reconstructive Surgery Vol.32 No.2s

두개저 골절 환자의 임상적 고찰

이용성,송시헌,김성호,김관태,김윤 대한신경외과학회 1994 Journal of Korean neurosurgical society Vol.23 No.9

The authors analyzed 147 cases of basal skull fracture which were treated in the Department of Neurosurgery, Chungnam National University Hospital from Janwuy 1989 to December 1992. These fractures are difficult to diagnose by ordinary X-ray examination and are freguently inferred by clinical signs. The clinical features and radiological findings were reviewed. The results of the analysis are summarized as follows 1) The basal skull fractures were more common in men than women-the ratio being 6 1 1. 2) In decreasing order of cause of basal skull fractures were traffic accident~(77%), fall down, assault and slipping. 3) The minor head injury, Glasgow Coma Scale Score(GCS) of 13 to 15, was 79 cases(54%), the moderate head injury 40 cases(27%) and the severe head injury 18 cases(1996). 4) In decreasing order of clinical features were otorrhea(71 I) rhinorrhea(4856) and raccoon eye(33%) etc. 5) In decreasing order of the combined pathologies were skull fracture(55I 1, subdural hema-toma(l7%), epidural hematoma(l6%) and intraerebral hematoma(l2I) etc. 6) The facial nerve, vestibulocochlear nerve and optic nerve were the most commonly injured cranial nerve. 7) CSF leakage was noted in 139 cases and among them immediate type was far more common(%%) than the delayed type. 8) The incidence of meningitis was 5.4% and most of them associated with CSF leakage and the prophylatic antibiotic treatment has no effect to decrease infection rate. 9) In decreasing order of the frequency associated injuries were facial bone fracture (47%), clavicle fracture(19%), lower extremitics fracture(9%) and upper extremcties fracture(7%) etc.

두개저 골절에 대한 임상적 고찰

이용행,이상걸,김승진,김병준 대한신경외과학회 1993 Journal of Korean neurosurgical society Vol.22 No.10

65 consecutive patients with basal skull fracture admitted to Eul-Ji General Hospital, between March 1990 and March 1993 was carried out to study it's clinical and radiological presentations, complications, and outcomes. 1) Two thirds of the patients were between 20 and 40 years old and 82% were male. 2) 78% of the injuried were by traffic accidents and 17% were by fall down. 3) The outcomes of treatment were related to initial GCS(Glasgow coma scale) of the patients. 4) Clinical features were ear bleeding -54%, Racoon's eye -35%, hemotympaneum -32%, hearing loss -25%. 5) The combined lesions were skull fractures -43%, facial bone fractures -31%, subdural hematoma -19%, epidural hematoma -14%, and pneumocephalus -14%. 6) The combined cranial nerves injuried were facial nerve -32%, vestibulocochlear nerve -12%, oculomotor nerve -12%, abducens nerve -12%. 7) The location of basal skull fracture according to clinical feature and CT bone window were middle cranial fossa -54%, on anterior cranial fossa -22%, anterior and posterior cranial fossa -12%, posterior cranial fossa 12%. 8) Clinical features associated with types of petrous bone fractures were analyzed. 9) The time of onset and the degree of facial palsy had a influence on recovery of facial nerve function and the types of hearing loss had a role in recovery of hearing function. 10) CSF leakage were present in 16 cases and immediate type was more than delayed type. 11) Three patients(4.6%) developed meningitis, especially associated with CSF leakage and it's rate was higher when CSF leakage persisted over 1 week.

소아 두개저 골절의 임상적 고찰

송시헌 충남대학교 의과대학 지역사회의학연구소 1997 충남의대잡지 Vol.24 No.2

The purpose of this study is to analyze clinical features of 51 patients, who have admitted Chungnam National University Hospital, from January 1, 1992, to, June 30, 1997, with basal skull fracture in children. The results were as follows: 1. The peak age was 3-12 year-old and occured predominantly in male(1.7:1 ratio). 2. The most common cause of trauma was traffic accident(80.4%). 3. The frequent clinical features, in decreasing order of frequency, were pneumocephalus(72.5%), CSF otorrnea(33.3%), raccoon eye(23.5%), CSF rhinorrhea(21.6%), and facial palsy(15.7%). 4. The basal skull fracture line was detected in only 49% of cases by skull X-ray film. 5. The degree of development of paranasal sinus were poor in 68.2%. 6. CSF leak was noted in 66.75 of cases and among them 79.5% of cases were stopped spontaneously.

두개기저부 골절 및 동반된 외상에 대한 임상적 고찰

김윤,우원철 충남대학교 의과대학 지역사회의학연구소 1998 충남의대잡지 Vol.25 No.2

The authors analyzed 74 cases of basal skull fracture which were treated in the Department of Neurosurgery, Chungnam National University Hospital from January 1985 to October 1998. Clinical features and radiological findings were reviewed and analyzed. The results of the analysis are summarized as follow: 1. The basal skull fracture were more common in man than woman. 2. 61% of the injured were by traffic accident and 35% were by fall down 3. The outcome of treatment were related to initial GCS(Glasgow coma scale) of the patients. 4. Clinical features were otorrhea(64%), rhinorrhea(49%), and raccoon eye(34%) etc in decreasing order. 5. Combined pathologies were pneumocephalus(58%), skull fracture(53%), epidural hematoma (24%), contusion(18%) etc in decreasing order. 6. CSF leakage were noted in 53 cases and immediate type of CSF leakage was more than delayed type 7. The facial nerve and optic nerve were the most commonly injured cranial nerve 8. The time of onset and the degree of facial palsy had a influence on recovery of facial nerve function. 9. Meningitis occured in 3 cases (4%) of basal skull fracture associated with CSF leakage

Sixth and Twelfth Cranial Nerve Palsies Following Basal Skull Fracture Involving Clivus and Occipital Condyle

Kim, Sung-Hoon,Kim, Seok-Won The Korean Neurosurgical Society 2012 Journal of Korean neurosurgical society Vol.51 No.5

Oblique basal skull fractures resulting from lateral crushing injuries involving both clivus and occipital condyle are rare due to their deep locations. Furthermore, these fractures may present clinically with multiple cranial nerve injuries because neural exit routes are restricted in this intricate region. The authors present an interesting case of basal skull fractures involving the clivus and occipital condyle and presenting with sixth and contralateral twelfth cranial nerve deficits. Clinico-anatomic correlations and the courses of cranial nerve deficits are reiterated. To the authors' knowledge, no other report has been previously issued on concomitant sixth and contralateral twelfth cranial nerve palsies following closed head injury.

두개저 골절 환자의 임상적 고찰

김한식,목진호,이규춘,이영배 동국대학교 경주대학 1997 東國論集 Vol.16 No.2

저자들은 최근 2년간 본원 신경외과에 입원 치료 받았던 두부외상 환자 중 자료 분석이 가능했던 119례의 두 개저부 골절 환자를 대상으로 임상 분석하여 다음과 같은 결론을 얻었다. 두부외상후 두개저 골절의 발생 빈도는 34%로 남녀 발생비는 5 : 1이었고, 활동기 연령인 20∼59세가 70.6%를 차지 하였다. 원인으로는 교통사고가 56.3%로 가장 많고 추락, 산재, 낙상, 구타 순이었으며, 내원당시 환자상태는 경증뇌손상(GCS 13-15)이 64.7%, 중증 뇌손상(3∼8) 21.8%, 중등도 뇌손상(9∼12) 13.5% 순이었고 예후도 GCS가 높을수록 양호하였다. 임상소견은 뇌척수액 비루(43.7%)가 가장 흔하고 비루(31.9%), 안와부 반상출혈(31.1%), 기뇌증(26.1%), 청각소실(18.5%)등이었다. 뇌척수액루의 지속 기간은 87.7%가 7일 이내였고 보존적 치료로 93.9%가 해결되었다. 2∼4주 지속된 경우는 요추천자 배액술, 4주 이상된 경우는 수술을 시행하였다. 뇌신경 손상은 안면신경마비가 31.7%로 가장 높았고 발현 시기는 지연성 마비가 69.2%, 조기마비가 30.8%였다. 뇌막염의 발생 빈도는 5.9%로 모두 뇌척수액루가 1주 이상 지속된 경우였고, 항생제 투여군과 비투여군의 뇌막염 발생율은 각각 6.1%와 4.8%로 항생제가 감염율을 낮추지는 못했다. 119 consecutive cases with basal skull fractures out of 343 head injuried patients who were treated in Pohang Hospital from July 1995 to July 1997 were analysed. The authors reviewed the clinical features, radiologic findings, complications and outcomes. Most of the patients(70.6%) were between 20 and 59 years old. The basal skull fractures were more common in men than women-the ratio being 5 : 1. The cause of BSF were traffic accident(56.3%), fall down, work related, silp down, and assults in decreasing order of frequency. The outcome of treatment wee related to initial GCS(Glasgow coma scale) of patients. The severity of head injury were mild(GCS13-15)-64.7%, Moderate(GCS9-12)-13.5%, and severe(GCS3-8)-21.8%, The most common feature of BSF were rhinorrhea(43.7%), otorrhea(31.3%), raccoon's eye(31.1%), pneumocephalus(26.1%), hearing disturbance(18.5%). Most of CSF leakage(86.7%) were noted within 24hours after injury and most of leakage(93.9%) were ceased by conservative management within 2 weeks, but one case that did not respond to conservative and lumbar drainage required operative repair. The facial nerve(31.7%) was the most frequently involved cranial nerve followed by vestibulocochlear and optic nerve. The onset of facial palsies were immediate in 30.8% and delayed 69.2%. The incidence of meningitis was 5.9% and the prophylactic antibiotics had no beneficial effect in reducing the infection rate.