CRANIAL BASE APPROACHES FOR TRAUMATIC LESIONS (CLINICAL EXPERIENCE IN 26 CONSECUTIVE CASES)

Twelve head injured patients with cerebrospinal fistula and/or pneumocephalus due to deep and extensive cranial base dura-brain lacerations were operated upon in order to be repaired of their defects intradurally using extended (basal) frontal approach or combined extended (basal) frontal approach and fronto-orbital approach. Six patients demonstrating frontobasal fracture and presenting with loss of vision, five patients with superior orbital fissure syndrome caused by a comminuted and extensive sphenoid ridge fractures, and three patients with orbital apex syndrome and sphenoid bone fracture were explored using fronto-orbital approach, and the traumatic region was explored and the involved cranial nerves were decompress. All of the patients whose frontobasal dural defects had been repaired did well, and no complications or recurrences the fistula or pneumocephalus occurred. Out of the patients with cranial nerve syndromes, postoperatively, three improved in vision significantly, one had a partial improvement in vision, and two superior orbital fissure patients improved minimally. The other eight cases did not change their neurological findings. The most striking factors in prognosis of the patients with traumatic cranial nerve compression are thought to be time of the surgical intervention and the type of the cranial nerve injury. These cranial base approaches provided a wide exposure and minimised the need of brain retraction.

TRAVMATÝK LEZYONLAR ÝÇÝN KAFA TABANI YAKLAÞIMLARI (26 OLGUDA KLÝNÝK DENEYÝM)

Kafa tabanýnda derin ve ekstansif dura-beyin laserasyonu sonucu geliþen serebrospinal sývý fistülü ve/veya pnömosefali olgularýnda (12 olgu) geniþletilmiþ (bazal) frontal yaklaþým ile ya da geniþletilmiþ (bazal) frontal yaklaþým ve fronto-orbital yaklaþým kombine edilerek intradural yoldan defekt onarýmý yapýlmýþtýr. Optik kanal bölgesinde frontobazal fraktüre baðlý geliþen optik sinir basýsý bulunan altý olguda, sfenoid kanatta parçalý ve yaygýn fraktürün neden olduðu superior orbital fýsür sendromu saptanan beþ olguda ve orbital apeks sendromu bulunan üç olguda ise fronto-orbital yaklaþým uygulanarak travmatize bölge eksplore edilmiþ ve etkilenen II., III.,IV. ve VI. kranyal sinirlerin dekompresyonu gerçekleþtirilmiþtir. Taban durasý defektinin onarýldýðý olgularýn hiçbirinde komplikasyon gözlenmemiþ, fistül ve pnömosefali rekürrensi saptanmamýþtýr. Kranyal sinir dekompresyonu yapýlan olgulardan üçünde vizyonda anlamlý düzelme, birinde vizyonda parsiyel düzelme ve iki superior orbital fisür sendromunda parsiyel iyileþme gözlenmiþtir. Kranyal sinir dekompresyonu olgularýnda sonucu etkileyen en önemli faktörlerin cerrahi giriþim zamaný ve sinirdeki yaralanma tipi olduðu izlenimi edinilmiþtir. Travmatik lezyonlarýnýn cerrahi tedavisi için kafa tabaný yaklaþýmý yapýlan 26 olgunun tümünde de yaklaþýmýn çok geniþ bir ekspojur saðladýðý ve nöral doku retraksiyonunu en aza indirdiði belirlenmiþtir.