Article
Combined orbitofrontal injuries
Kombinierte orbitofrontale Verletzungen
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Authors
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W. Sollmann
- Neurochirurgische Klinik, Städtisches Klinikum Braunschweig
| Published: | April 11, 2007 |
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Outline
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Objective: Although the energy absorbing effect of the craniofacial soft tissue and bone gives some protection to the brain, orbitofrontal injuries may cause severe complications and neurological deficits requiring staged multidisciplinary treatment.
Methods: From 1985 to 2006, 163 patients suffering from complex orbitofrontal injuries were treated. Their therapies and clinical courses were evaluated retrospectively.
Results: Two thirds of the patients had traffic accidents, working accidents as well as criminal attacks with firearms, hitting or stabbing were less frequent. On admission, 68% of the patients were comatose with a GCS<8. Rupture, contusion or laceration of the eyeball occured in 47% of the patients. Cranial nerve deficits were frequent: 58% impaired vision, 30% anosmia, 21% oculomotor disturbances, 3% facial or cochlear nerve lesions. 89% required neurosurgical operations: elevation or debridement of impressed fractures and bone splinters (55%), evacuation of hematomas (13%), frontobasal duraplasty (17%), secondary cranioplasty (4%) as well as trapping or embolisation of carotid-cavernous sinus fistulas (6%). 67% of the patients could be treated in one interdisciplinary session, 28% had to undergo up to 4 secondary operations. There were 19% fatalities, 2% vegetative states and 18% severely disabled patients, mostly because of visual deficits and psychological deficits.
Conclusions: The prognosis is determined by the severity of the brain injuries and the cerebral complications. Most patients can be treated in one interdisciplinary session starting with decompression of the brain, reconstruction of eyelids and globe followed by reconstruction of the skull and dura. Extensive frontobasal fractures with brain prolapse should be treated by transcranial surgery, well evaluated small fractures can be treated by the transnasal route even without a time interval. Secondary vascular injuries can occur leven after an interval of days or weeks and should be treated by endovascular methods.
