Basefrakturer

Basefrakturer, commonly known in English as skull-base fractures, are fractures that involve the base of the skull. They arise from significant cranial trauma, most often high-energy injuries such as motor vehicle collisions or falls. The skull base consists of the anterior, middle, and posterior fossae and contains openings for cranial nerves and major vessels; fractures may affect the temporal bone, sphenoid, or occipital regions.

Classification and presentation vary. Skull-base fractures can be linear or complex, and may be open or closed depending on whether bone fragments breach the overlying soft tissues. Clinical features often reflect injury to nearby structures and may include raccoon eyes, battle signs, hemotympanum, and cerebrospinal fluid leakage from the nose or ears. Cranial nerve deficits and signs of intracranial injury may also occur.

Diagnosis relies on imaging and clinical assessment. Computed tomography is the preferred modality for detecting fractures and associated injuries. If a rhinorrhea or otorrhea is present, testing for beta-2 transferrin can help confirm a CSF leak. Ongoing neurologic evaluation is essential to identify evolving intracranial problems.

Management is tailored to the individual injury. Many skull-base fractures are managed nonoperatively with careful observation, head elevation, and monitoring for complications. Antibiotics are not routinely given unless there is a confirmed infection, a persistent CSF leak, or penetrating injury. Surgical repair is considered for persistent CSF leaks, vascular injuries, or progressive neurological deficit, or when bony fragments threaten critical structures.

Complications can include meningitis from CSF leakage, persistent cranial nerve dysfunction, and other intracranial injuries. Prognosis varies with the extent of injury and the presence of associated brain trauma, with many patients recovering without major disability while others experience longer-term deficits. See also skull fracture and CSF leakage.