BACKGROUND: Traumatic internal carotid artery (ICA) occlusion is a rare complication of skull base fractures, characterized by high mortality and disability rates, and poor prognosis. Therefore, timely discovery and correct management are crucial for saving the lives of such patients and improving their prognosis. This article retrospectively analyzed the imaging and clinical data of three patients, to explore the imaging characteristics and treatment strategies for carotid artery occlusion, combined with severe skull base fractures.
METHODS: This case included three patients, all male, aged 21, 63, and 16 years. They underwent plain film skull computed tomography (CT) examination at the onset of their illnesses, which revealed fractures at the bases of their skulls. Ultimately, these cases were definitively diagnosed through CT angiography (CTA) examinations. The first patient did not receive surgical treatment, only anticoagulation therapy, and recovered smoothly with no residual limb dysfunction (Case 1). The other two patients both developed intracranial hypertension and underwent decompressive craniectomy. One of these patients had high intracranial pressure and significant brain swelling postoperatively, leading the family to choose to take him home (Case 2). The other patient also underwent decompressive craniectomy and recovered well postoperatively with only mild limb motor dysfunction (Case 3). We retrieved literature from PubMed on skull base fractures causing ICA occlusion to determine the imaging characteristics and treatment strategies for this type of disease.
CONCLUSIONS: For patients with cranial trauma combined with skull base fractures, it is essential to complete a CTA examination as soon as possible, to screen for blunt cerebrovascular injury.

Pediatric basilar skull fractures (BSFs) are a rare type of traumatic head injury that can cause debilitating complications without prompt treatment. Here, we sought to review the literature and characterize the clinical features, management, and outcomes of pediatric BSFs. We identified 21 relevant studies, excluding reviews, meta-analyses, and non-English articles. The incidence of pediatric BSFs ranged from 0.0001% to 7.3%, with falls from multi-level heights and traffic accidents being the primary causes (9/21). The median presentation age ranged from 3.2 to 12.8 years, and the mean age of patients across all studies was 8.68 years. Up to 55% of pediatric BSFs presented with intracranial hematoma/hemorrhage, along with pneumocephalus and edema. Cranial nerve palsies were a common complication (9/21), with the facial nerve injured most frequently (7/21). While delayed cranial nerve palsy was reported in a few studies (4/21), most resolved within three months post-admission. Other complications included CSF leaks (10/21) and meningitis (4/21). Management included IV fluids, antiemetics, and surgery (8/21) to treat the fracture directly, address a CSF leak, or achieve cranial nerve compression. Despite their rarity, pediatric skull base fractures are associated with clinical complications, including CSF leaks and cranial nerve palsies. Given that some of these complications may be delayed, patient education is critical.

The anatomically complex craniofacial skeleton demands special consideration when caring for cases of polytrauma or medically compromised patients with craniofacial fractures. This paper utilises a systematic review and multidisciplinary opinions to create an algorithm for the hospital-based care of patients with craniofacial fractures (base of skull, orbit, paranasal sinus, and mandible) who require non-invasive ventilation (NIV). Each fracture location has a unique predisposition to a different type of emphysema and associated morbidity. The risk of developing emphysema, combined with its potential severity, is stratified against the harm of not providing NIV for the holistic care of the patient. The aim of this paper is to synthesise evidence from a systematic review of existing literature with multidisciplinary opinions to develop a concise algorithm that outlines the optimal treatment of patients with craniofacial fractures who require NIV.

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UNASSIGNED: Anterior skull base fractures represent a unique challenge for neurosurgical repair due to the potential for orbital injury and the proximity to the air sinuses, yielding increased possibility for infection, and persistent cerebrospinal fluid (CSF) leak. While multiple techniques are available for the repair of anterior skull base defects, there exists a paucity of robust, long-term clinical data to guide the optimal surgical management of these fractures.
UNASSIGNED: We present the case of a complex, traumatic penetrating anterior skull base fracture, and describe a multi-layered approach for successful repair - namely, with the use of a temporally-based pericranial flap, split-thickness frontal bone graft, and autogenous abdominal fat graft. The patient was followed for nine months postoperatively, over which time she experienced no significant complications.
UNASSIGNED: The goal of successful anterior skull base repair involves creating a durable, watertight separation between intra and extracranial compartments to prevent CSF leak, protect intracranial structures, and minimize infection risk. The temporally-based pericranial flap, split-thickness frontal bone graft, and autogenous abdominal fat graft represent safe and efficacious approaches to achieve lasting repair.

The most common cause of lateral skull base fractures are still road traffic accidents, followed by falls. The radiologic classification into otic capsule-sparing or otic capsule-violating fractures correlates well with an increased risk of injury to the sensitive structures of the middle ear with otic capsule-violating fractures. In case of immediate onset complete facial nerve paralysis, decompression surgery is generally recommended if bony impingement can be demonstrated on high-resolution CT of the temporal bone. For many other facials nerve complications, recent publications have achieved good to excellent facial nerve recovery rates with watchful waiting under conservative treatment with prednisolone administration.
UNASSIGNED: Nach wie vor sind der Verkehrsunfall an erster und Stürze aus großer Höhe an zweiter Stelle die häufigsten Ursachen einer Laterobasisfraktur. Die radiologische Einteilung nach extra- und translabyrinthären Frakturen korreliert dabei gut mit dem erhöhten Risiko einer Begleitverletzung der sensiblen Strukturen im Mittelohr bei translabyrinthären Frakturformen. Sollte es zu einer kompletten Sofortparese des N. facialis mit frakturbedingter Einengung des knöchernen Kanals des Nervs kommen, besteht eine Operationsindikation. Ansonsten sollte individuell und interdisziplinär diskutiert werden, welche therapeutische Maßnahme infrage kommt, da auch ein konservatives Zuwarten laut Literatur zu einem hohen Prozentsatz zu guten Ergebnissen geführt hat.

OBJECTIVE: Multi-level fall (MLF) accounts for 26.5%-37.7% of traumatic pediatric basilar skull fractures (BSFs). There is a dearth of information concerning recommendations for work-up, diagnosis, treatment, and otolaryngological follow-up of pediatric basilar skull fractures secondary to MLFs. Through a systematic literature review and retrospective review of an institution\'s trauma experience, we sought to identify clinical findings among pediatric MLF patients that indicate the need for otolaryngological follow-up.
METHODS: A two-researcher team following the PRISMA guidelines performed a systematic literature review. PubMed, Web of Science, and EBSCO databases were searched August 16th, 2020 and again on November 20th, 2021 for English language articles published after 1980 using search terms Pediatric AND (fall OR \"multi level fall\" OR \"fall from height\") AND (\"basilar fracture\" OR \"basilar skull fracture\" OR \"skull base fracture\" OR \"skull fracture\"). Simultaneously, an institutional trauma database and retrospective chart review was performed for all patients under age 18 who presented with a MLF to a pediatric tertiary care center between 2007 and 2018.
RESULTS: 168 publications were identified and 13 articles reporting pediatric basilar skull fracture data and MLF as a mechanism of injury were selected for review. MLF is the most common etiology of BSF, accounting for 26.5-37.7% of pediatric BSFs. In the retrospective review, there were 180 cases of BSF from MLF in the study period (4.2%). BSF and fall height were significantly associated (p < 0.001), as well as presence of a CSF leak and fall height (p = 0.02), intracranial hemorrhage (ICH) (p = 0.047), and BSF fracture type (p < 0.001). However, when stratified by age, these associations were only present in the younger group. Of those with non-temporal bone BSFs (n = 71), children with hemotympanum (n = 7) were approximately 18 times more likely (RR 18.3, 95% CI 1.89 to 177.02) than children without hemotympanum (n = 64) to have hearing loss at presentation (28.6% vs. 1.6% of patients).
CONCLUSIONS: MLF is the most common cause of pediatric basilar skull fractures. However, there is limited information on the appropriate work-up or otolaryngologic follow-up for this mechanism of injury. Our retrospective review suggests fall height is predictive for BSF, ICH, and CSF leak in younger children. Also, children with non-temporal bone BSFs and hemotympanum may represent a significant population requiring otolaryngology follow-up.

Jean-Martin Charcot coined the term Duchenne-Aran atrophy. The inversion of names compared to standard practice shows the respect Charcot had for Guillaume Duchenne de Boulogne, who had encouraged him to study nervous disease. Using innovative localised electrification, Duchenne identified various types of muscular atrophy which he distinguished from paralysis. But it was François-Amilcar Aran who, published the observations that he had compiled and studied with Duchenne\'s help first in 1848 and again in 1850. The result was the seminal articles that led to the eponym \"Aran-Duchenne hand\". Focusing on the second half of the nineteenth century in Paris, this article will explore how knowledge evolved around the nosography of different types of muscular atrophy, starting with Duchenne and Aran and then with Charcot and his students, notably Albert Gombault, Joseph Babiński, Fulgence Raymond, and Jean-Baptiste Charcot. This historical overview is accompanied by a biographical account aimed at rescuing Aran from the sea of oblivion and covering the other subjects he wrote about, especially in neurology: including cerebral hydatid disease, skull base fractures and \"cancer of the dura mater\".

UNASSIGNED: To summarize the presentation, diagnosis, and management of cerebrospinal fluid (CSF) leaks in the setting of traumatic anterior skull base fracture.
UNASSIGNED: Wide literature research has been performed as well as the authors\' own clinical experience has been summarized.
UNASSIGNED: Articles from the most recent 30 years have been reviewed and a typical case of our own has been presented. Based on the most updated evidence, a treatment algorithm for CSF leaks has been proposed.
UNASSIGNED: Anterior skull base fracture accounts for about 4% of all head injuries and CSF leaks is a complication that commonly presents with clear fluid emanating from the nasal passage. A positive beta-2-transferrin study is highly specific for diagnosis, while thin-slice CT scanning and MRI cisternography are also useful tools. The majority of the CSF leaks tend to be resolved spontaneously, and conservative management is attempted first with or without the augmentation of a lumbar drain. Surgical management mainly includes open surgery and endoscopic surgery, which have their own pros and cons.

Objectives  Cerebrospinal fluid (CSF) leaks are a possible complication in patients with skull base fractures (SBFs). The widely cited incidence of CSF leaks is 10 to 30% in SBF patients; however, this estimate is based only on a few outdated studies. A recent report found CSF leaks in <2% SBF patients, suggesting the incidence may be lower now. To investigate this, we report here our institutional series. Design  This study is a retrospective chart review. Setting  The study was conducted at two major academic medical centers (2000-2018). Participants  Adult patients with SBF were included in this study. Main Outcome Measures  Variables included age, gender, CSF leak within 90 days, management regimen, meningitis within 90 days, and 1-year mortality. Results  Among 4,944 patients with SBF, 199 (4%) developed a CSF leak. SBF incidence was positively correlated with year of clinical presentation ( r -squared 0.78, p  < 0.001). Among CSF leaks, 42% were conservatively managed, 52% were treated with lumbar drain, and 7% required surgical repair. Meningitis developed in 28% CSF leak patients. The 1-year mortality for all SBF patients was 11%, for patients with CSF leaks was 12%, and for patients with meningitis was 16%. Conclusion  In the largest institutional review of SBF patients in the 21st century, we found CSF leak incidence to be 4%. This is lower than the widely cited range of 10 to 30%. Nevertheless, morbidity and mortality associated with this complication remains clinically significant, and SBF patients should continue to be monitored for CSF leaks. We provide here our institutional treatment algorithm for these patients that may help to inform the treatment strategy at other institutions.