PubMed · 459802
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W Weinrich, A Drees, P Haller, H Müller, U Patzold, J Dahmer. 1979-05-11. [Basic text: brain injuries].. https://pubmed.ncbi.nlm.nih.gov/459802/
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The study of CSF fistulae, and especially those involving otolaryngological anomalies, must be based on the search for the causative problem of recurrent meningitis. Congenital malformations, post-traumatic and post-operative situations or even diseases involving the cranial bones are basic causes that should be studied. Currently, cranial trauma is the most usual cause of CSF fistulae, with the possibility of recurrent bacterial meningitis.
A series of 129 patients harbouring extradural hematomas was analysed considering the neurological state immediately before operation as the most consistent variable. Seventy eight patients were considered to be comatose (Group I) and 51 were noncomatose. Among the comatose group, 30 were investigated with computerized tomography (23.3% mortality, 50% good results), 31 were submitted to angiography (48.3% mortality, 38.7% good results), and 17 were operated based on the neurological examination and skull radiography (47% mortality, 35.2% good results). The presence or absence of skull fracture and the density of hematoma did not change the final outcome. Associated intracranial lesions increased the mortality and lowered the good results in both groups. Frontal hematomas (10 cases) in the comatose group were associated with high mortality (52.6%) due to bad neurological state (Glasgow 3-5) and to isolated or multiple intracranial associated lesions (6 patients).
Peculiarities of performance of the reconstructive operation performed in 350 patients at primary surgical treatment, or later on, at the period of primary treatment of a patient at a hospital and at his readmission with the aim of cranioplasty are considered. The authors recommend to perform the reconstructive operation in presence of a cranial vault defect at the time of primary surgical treatment, or 2-5 weeks later, when preparing a patient for such an operation.