Skull Base Fracture as a Predictor for Intracranial Bleeding in Patients with Head Injury Treated in Hasan Sadikin Hospital, Bandung from April 2009 April 2010.

Skull Base Fracture as a Predictor for Intracranial Bleeding in Patients with Head Injury Treated in Hasan Sadikin Hospital, Bandung from April 2009 – April 2010

Department of Neurosurgery Faculty of Medicine Padjadjaran University / Hasan Sadikin Hospital Bandung 1 Skull Base Fracture as a Predictor for Intracranial Bleeding in Patients with Head Injury

Treated in Hasan Sadikin Hospital, Bandung from April 2009 – April 2010

Arwinder Singh, M.Z. Arifin

Department of Neurosurgery / Faculty of Medicine Padjadjaran University / Hasan Sadikin Hospital Bandung

Background : The incidence of head injury is 300 per 100,000 per year (0.3% of the population), with a mortality of 25 per 100,000. A head injury may cause a skull fracture, which may or may not be associated with injury to the brain. In essence, a skull base fracture is a linear fracture at the base of the skull which occurs in 5 – 20% of head injuries. Patients with fractures of the petrous temporal bone present with CSF otorrhea and bruising over the mastoids, ie, Battle signs whereas patients with anterior skull base fracture present with rhinorhea and periorbital brusing. Loss of consciousness and Glasgow Coma Score may vary depending on an associated intracranial pathology such as epidural hemorrhage, subdural hemorrhage, intracerebral hemorrhage, cerebral contusion, subarachnoid hemorrhage and intraventricular hemorrhage.

Objective : To define the relationship between skull base fractures and intracranial bleeding in patients with head injury.

Methods and Design : Analysis of data obtained from a retrospective review of medical records and from a systematized database pertaining to patients with skull base fracture associated with intracranial bleeding caused by head trauma treated in theNeurosurgery ward of the Hasan Sadikin Hospital, Bandung from April 2009 – April 2010. Skull base fracture was confirmed using radiological study including both skull x-ray and head CT Scan.

Results : There were a total of 249 patients (193 male, 56 female) with skull base fracture and intracranial bleeding who were divided into three groups. Group 1 unilateral / bilateral middle fossa skull base fracture comprising 184 patients (137 male, 35 female), group 2 anterior skull base fracture comprising 42 patients (35 male, 7 female) and group 3 with both anterior and middle fossa skull base fracture comprising 23 patients (21 male, 2 female). The average age in these groups was 31.35, 34.86 and 31.39 years respectively and GCS during admission was 11.83, 12.24 and 11.70. Cerebral contusion correlated significantly with middle fossa skull base fracture (p=0,004) whereas no significant correlation was found in the anterior fossa skull base fracture group. Subdural hemorrhage correlated with patients who had both anterior and middle fossa skull base fracture (p=0,010).