Diagnosis

Important for the diagnosis are first of all the medical history and a possible course of the accident as well as the physical examination, whereby special attention is paid to external injuries, consciousness, pupil reaction and function of the brain nerves. Then a cranial computer tomogram (cCT) (CT of the head) is made, which also allows the evaluation of the brain and possible bleeding. In addition, an x-ray of the skull and cervical spine can be made, but this is usually not necessary if the cCT is present.

If, in addition to the skull base fracture, the brain, cranial nerves or the eye socket are injured, an MRI of the head can be made as an alternative to the computer tomogram. If fluid leaks from the nose or ear, its origin is determined using a special substance. The decisive question, namely whether the fluid is cerebrospinal fluid, is tested by determining the content of ?2-transferrin (iron transport protein).

If the result is positive, the liquid is cerebrospinal fluid (cerebrospinal fluid) and thus comes out of the head, since only this substance is contained in it. The skull base fracture is divided into two groups depending on its location: The frontobasal skull base fracture affects the nose and paranasal sinuses and is located at the front of the skull. The laterobasal skull base fracture includes the ear and petrous bone and is located at the side of the skull.

They can be further subdivided into longitudinal petrosal fracture (fracture line in longitudinal direction) and transverse petrosal fracture (fracture line in transverse direction). A further subdivision takes into account the type of basal skull fracture: The frontobasal basal skull fracture is usually caused by accidents (work, traffic accidents) after the application of force to the forehead-nose-area. The laterobasal skull base fracture, on the other hand, is caused after lateral force is applied (longitudinal petrosal fracture) or after force is applied to the forehead or the occiput (transverse petrosal fracture).

Bursting fracture = occurs when the force is applied from the side over a large area; the bone bursts, whereby the fragments are displaced outwards in a circle
Impression fracture = caused by acute force
Frontobasal fracture
Laterobasal fracture

The treatment of a skull base fracture depends on the extent of the injury.If there is no dislocation of the individual fragments, no therapy is required except for initial monitoring for bleeding. Otogenic cerebrospinal fluid leakage from the ear (otogenic cerebrospinal fluid) in laterobasal fractures is treated with antibiotics. The therapy is different if, in addition to the basal skull fracture, cranial nerves are injured or cerebrospinal fluid leaks from the nose (frontobasal fracture). In these cases, surgical treatment in combination with antibiotic treatment should be sought. During surgery, the bony structures are treated and the meninges surrounding the brain are sutured.