Microsurgical treatment of frontal lobe brain contusion complicated with anterior cranial base and cranio-orbital traumatic fractures

XU Ming-wei; REN Ming-liang; LIANG Hong; XU Lun-shan; XU Min-hui

doi:10.3969/j.issn.1009-4237.2018.06.007

Abstract：Objective To explore the microsurgery treatment methods and effects for the frontal lobe brain contusion complicated with anterior cranial base and cranio-orbital traumatic fractures.Methods The clinical manifestations and surgical treatment of 18 patients with frontal lobe brain contusion complicated with anterior cranial base and cranio-orbital traumatic fractures were analyzed retrospectively.There were 16 males and 2 females,aged of 35-68(average 41.5) years.Cause of injury included 9 cases of traffic accident,7 cases of foreign body impact inju-ry,1 case of falling injury,and 1 case of strikes injury.At the time of admission,GCS score was 13-15 points in 3 cases,9-12 points in 7 cases and 5-8 points in 8 cases.All 18 patients underwent microscopically contusion and he-matoma removal,and the one stage of skull base reconstruction and repair was performed.Three patients accepted the one stage cranio-orbital decompressive operation.Results All patients were followed up for 6 months to 2 years,and GOS scored 5 points in 11 cases,4 points in 5 cases,3 points in 1 case ,and 1 case was dead.Two cases of cerebrospinal fluid leakage were observed in the early postoperative period ,and the cerebrospinal fluid leakage disappeared in 2 weeks after conservative treatment.One of the three patients with visual impairment had improved vision after surgery.Conclusion Early thorough debridement ,thorough removal of frontal lobe contusion and he-matoma under a microscope ,carefully sutured dura mater ,one stage repair for the anterior cranial base and cranio-or-bital traumatic fractures,early optic canal decompression for optic nerve injury patients and postoperative comprehen -sive treatment can reduce nerve dysfunction and improve the prognosis of patients .