Diagnosis and Surgical Treatment of Injuries of the Posterior Cranial Fossa Structures

V.V. Krylov, A.E. Talypov, N.S. Kuksova, Yu.S. Ioffe

(Sklifosovsky Research Institute of Emergency Care, Moscow)

The article deals with the results of examination and treatment of 61patients with injuries of the posterior cranial fossa (PCF) structures, admitted during 01.01.90-31.05.02. Clinical-neurologic examination, X-ray of the skull, CT of the brain, neuroophthalmologic examination, recording of acoustic sensory evoked potentials (ASEVP) were carried out.

Injuries of the PCF structures accounted for 0.6% of all craniocerebral trauma and 1.4% of patients, operated for it. Epidural hematomas of the PCF, intracerebellar hematomas and cerebellar contusions made 54%, 11% and 35% respectively. The latter spread supratentorially in 24% of cases.

The analysis of clinical and instrumental data was the basis for distinguishing three clinical-anatomic forms of injuries of the PCF structures. They had reliable difference in clinical manifestations, a course and outcomes.

Versions of clinical manifestations of such injuries and factors, effecting a consciousness level, a course and prognosis, were determined.

The rate of occlusive hydrocephalus, observed in some cases with injuries of the PCF structures, was estimated (39%); factors, causing its development, were found out. ASEVP were recorded with the purpose of estimating a state of the brain stem and a degree of its compression. Interrelations between these potentials and CT signs watched in injuries of the PCF structures, were revealed. It allowed to use ASEVP for choosing treatment tactics and outcome prognostication.

Indications for surgical treatment and criteria of treatment tactics (surgical, conservative or temporizing) were determined. Risk factors in surgical treatment were as follows: a volume of injury, a consciousness level, presence of occlusive hydrocephalus, associated supratentorial injuries.