Author(s)
Jan Hemza, MD, PhD, PhD, MPA
Affiliation(s)
Dpt. of Neurosurgery Faculty Hospital at Saint Ann
Abstract:
<p>Our group have more than 493 patients: the anterior skull base, middle, posterior open trauma.During anterior skull base reconstruction we protected the olfactory structures in 91%. Mortality v our series is 1,7%, morbidity posttraumatic 17%, postoperative 0,6%.</p> <p>Follow up in this series is 27 years.</p> <p>In our series we prefered acute operations and reconstructions of open skull base fracture with very effective goal. In reconstruction method we preffered vascularized flaps for reconstruction of dura. Author discussed problems of acute and delay reconstruction, discussed mortality and morbidity. Authors have experiences 27 years with acuta operations and reconstructions, diagnostic technics, treatment and follow up of patients.</p> <p>Concurently with timing surgery study of open skull base fracture we have constituted group non-surgery treatment open skull base fracture. Our study group have together 116 cases, which come into being first 5 years. We have follow up of the group 20 years. We were all eyes on complications, which developing during 15-20years under different diagnosis: meningitis, meningoencephalis, abscessus cerebri, liquorhoea, pneumocephalus, Pott´s tumor, mucocoele, meninogencephalocoele, „polyps of paranasal sinuses“, „polyps of middle ear“, „cholesteatoma of middle ear“. </p> <p>The criteria – our characteristics of choices to the non- surgery group:</p> <p>only intradural pneumopcephalus intradural pneumocephalus and liquorhoea, which stop during 24-48hours only liquorhoea, which stop during 24-48hours. </p> <p>The first group have maximum between half and 1 year after trauma after diagnosis (15,5%), the second group between 5-6 yy (12,1%), the third group between 11-13yy. (13,9%) and forth group 16-18yy. (9,4%).</p> <p>We need to do exchanges conservetive treatment to surgery treatment in 58,6% during 20yy. under different diagnosis. If became the diagnosis after trauma late, the diagnosis have not immediate relation to traumatic diagnosis.</p> <p>We study different pathological problems posttraumatic on olfactory structures - destruction or contusion or hematoma into olfactory bulb, destruction of olfactory tract and destruction or contusions in olfactory trigonum.</p> <p>In lecture author will be discussed about new anatomical aspect of skull base, the biomechanical aspect of dura mater, the technical notes of different approaches of reconstruction, problems of timming of reconstruction or the contraversies between conservative and surgery treatment. </p> <p>In our series we prefered acute operations and reconstructions of open skull base fracture with very effective goal. In reconstruction method we preffered vascularized flaps for reconstruction of dura. Author discussed problems of acute and delay reconstruction, discussed mortality and morbidity. Authors have experiences 27 years with acuta operations and reconstructions, diagnostic technics, treatment and follow up of patients.</p>