Neurosurgical Management in Head Injuries

  • Karl Kothbauer
  • Mariel Laak ter PoortEmail author
  • Abolghassem Sepehrnia


Depending on the size and extent of the osseous injuries to the craniofacial area, there are associated intracranial injuries in about 20–30% of the cases (Manson et al. 1987; Neidhardt 2002). In the present series, 56% of all patients were found to have at least a dural tear, whereas in only 17% a dural injury was suspected before surgery. On imaging studies, additional cerebral contusions were seen in 42%, brain edema in 11%, and intracranial hemorrhages in 25%.


  1. Barnes CA, et al. Optic nerve decompression for traumatic optic neuropathy. Medscape. 2015;1:1–6.Google Scholar
  2. Barrow DL, Spector RH, Braun IF, Landman JA, Tindall SC, Tindall GT. Classification and treatment of spontaneous carotid-cavernous sinus fistulas. J Neurosurg. 1985;62(2):248–56.CrossRefPubMedGoogle Scholar
  3. Bruce JN, Kasim M, Housepian EM. Surgical management of intra-orbital tumours. In: Schmiedek HH, Sweet WH, editors. Operative neurosurgical techniques, vol. 1. 2006. p. 165–75.Google Scholar
  4. Buchanan RJ, Brant A, Marshall LF. Traumatic cerebrospinal fluid fistulas. In: Winn HR, editor. Youmans neurological surgery. 4th ed. Philadelphia: Saunders; 2004. p. 5265–72.Google Scholar
  5. Bullock R, Chesnut RM, Clifton G, et al. Guidelines for the management of severe head injury. Brain Trauma Foundation. Eur J Emerg Med. 1996;3:109–27.CrossRefPubMedGoogle Scholar
  6. Bullock MR, Chesnut R, Ghajar J, et al. Surgical management of acute epidural hematomas. Neurosurgery. 2006a;58(3 Suppl):S7–S15.PubMedGoogle Scholar
  7. Bullock MR, Chesnut R, Ghajar J, et al. Surgical management of acute subdural hematomas. Neurosurgery. 2006b;58(3 Suppl):S16–24.PubMedGoogle Scholar
  8. Bullock MR, Chesnut R, Ghajar J, et al. Surgical management of depressed skull fractures. Neurosurgery. 2006c;58(3 Suppl):S56–60.PubMedGoogle Scholar
  9. Bullock MR, Chesnut R, Ghajar J, et al. Surgical management of traumatic parenchymal lesions. Neurosurgery. 2006d;58(3 Suppl):S25–46.PubMedGoogle Scholar
  10. Carney N, Totten AM, et al. Guidelines for the management of severe traumatic brain injury, fourth edition. Neurosurgery. 2017;80(1):6–15.PubMedGoogle Scholar
  11. Chen CT, Wang TY, Tsay PK, Huang F, Lai YP, Chen YR. Traumatic superior orbital fissure syndrome: assessment of a cranial nerve recovery in 33 cases. Plast Reconstr Surg. 2010;126(1):205–12.CrossRefPubMedGoogle Scholar
  12. Chien Chen CT, Chen JR. Craniofac Trauma Reconstr. 2010;3(1):9–16.CrossRefGoogle Scholar
  13. Chiu SC, Hung HS, Linn SC, Chiang E, Liu DD. Therapeutic potential of olfactory ensheathing cells in neurodegenerative diseases. J Mol Med. 2009;87:1179–89.CrossRefPubMedGoogle Scholar
  14. Collet S, Grulois V, Bertrand B, Rombaux P. Post-traumatic olfactory dysfunction: a cohort study and update. B-ENT. 2009;5:97–107.PubMedGoogle Scholar
  15. Cooper PR, Moody S, Clark WK, Kirkpatrick J, Maravilla K, Gould AL, Drane W. Dexamethasone and severe head injury. A prospective double-blind study. J Neurosurg. 1979;51:307–16.CrossRefPubMedGoogle Scholar
  16. Costanzo RM, Zasler MD. Smell and taste in health and disease. In: Getchell TV, Doty RL, Bartoshuk LM, Snow Jr JB, editors. Head trauma. New York: Raven Press; 1991. p. 711–30.Google Scholar
  17. Dagi TF, George EG. The management of cerebrospinal fluid leaks. In: Schmidek HH, Sweet WH, editors. Operative neurosurgical techniques, vol. I. 2nd ed. Philadelphia: Saunders; 1988. p. 57–69.Google Scholar
  18. De Brun G. Treatment of traumatic carotid cavernous fistula using detachable balloon catheters. AJNR. 1983;4:355–6.Google Scholar
  19. Dearden NM, Gibson JS, McDowall DG, Gibson RM, Cameron MM. Effect of high-dose dexamethasone on outcome from severe head injuries. J Neurosurg. 1986;64:81–8.CrossRefPubMedGoogle Scholar
  20. Ducruet AF, Grobelny BT, Zacharia BE, et al. The surgical management of chronic subdural hematoma. Neurosurg Rev. 2012;35(2):155–69.CrossRefPubMedGoogle Scholar
  21. Flanagan JC, McLachlan DL, Shannon GM. Orbital roof fractures. Neurologic and neurosurgical considerations. Ophthalmology. 1980;87:325.CrossRefPubMedGoogle Scholar
  22. Fonseca RJ. Cerebrospinal fluid rhinorrhea and otorrhea. In: Fonseca RJ, editor. Oral and maxillofacial surgery, vol. 3. Philadelphia: Saunders; 2000. p. 187–8.Google Scholar
  23. Fonseca RJ, Walker RV. Oral and maxillofacial trauma, vol. 1. Philadelphia: Saunders; 1991.Google Scholar
  24. Geijerstam JL, Britton M. Mild head injury – mortality and complication rate: meta-analysis of findings in a systematic literature review. Acta Neurochir. 2003;145:843–50.CrossRefGoogle Scholar
  25. Georgiade N, Georgiade G, Riefkohl R, Barwick W, editors. Essentials of plastic maxillofacial and reconstructive surgery. Baltimore: Williams and Wilkins; 1987.Google Scholar
  26. Godbersen GS, Kügelgen C. Klassifikation von Stirnhöhlenwandfrakturen. In: Schmelzle R, editor. Schädelbasischirurgie. Damaskus: Al-Budoor; 1998a. p. 22–7.Google Scholar
  27. Godbersen GS, Kügelgen C. Operative Versorgung von Duraverletzungen nach Stirnhöhlenwandfraktur. In: Schmelzle R, editor. Schädelbasischirurgie. Al-Budoor: Damaskus; 1998b. p. 187–91.Google Scholar
  28. Gruss JS, Ellenbogen RG, Whelan MF. Craniofacial trauma. In: Winn HR, editor. Youmans neurological surgery. 4th ed. Philadelphia: Saunders; 2004. p. 5243–64.Google Scholar
  29. Hamby WB. Carotid cavernous fistulas. Springfield: Charles C. Thomas; 1966.Google Scholar
  30. Hubbard JL, Thomas JM, Pearson PW, et al. Spontaneous cerebrospinal fluid rhinorrhoea. Evolving concepts in diagnosis and surgical management. Neurosurgery. 1985;16:312.Google Scholar
  31. Hughes B. The results of injury to special parts of the brain and skull. In: Rowbotham GF, editor. The cranial nerves: acute injuries of the head. 4th ed. Edinborough: Livingstone; 1964.Google Scholar
  32. Hutchinson PJ, Kolias AG, Timofeev IS, Corteen EA, Czosnyka M, Timothy J, Anderson I, Bulters DO, Belli A, Eynon CA, Wadley J, Mendelow AD, Mitchell PM, Wilson MH, Critchley G, Sahuquillo J, Unterberg A, Servadei F, Teasdale GM, Pickard JD, Menon DK, Murray GD, Kirkpatrick PJ. Trial of decompressive craniectomy for traumatic intracranial hypertension. N Engl J Med. 2016;375(12):1119–30.CrossRefPubMedGoogle Scholar
  33. Jamieson KG, Yelland JD. Surgical repair of the anterior fossa because of rhinorrhoea aerocele or meningitis. J Neurosurg. 1973;39:328.CrossRefPubMedGoogle Scholar
  34. Jimenez DF, Sundrani S, Barone CM. Posttraumatic anosmia in craniofacial trauma. J Craniomaxillofac Trauma. 1997;3:8–115.PubMedGoogle Scholar
  35. Joseph DK, Dutton RP, Aarabi B, Scalea TM. Decompressive laparotomy to treat intractable intracranial hypertension after traumatic brain injury. J Trauma. 2004;57(4):687–9.CrossRefPubMedGoogle Scholar
  36. Joss U, Piffko J, Meyer U. Behandlung von frontobasalen Traumen und Polytraumen. Mund Kiefer Gesichtschir. 2001;5:86–93.CrossRefGoogle Scholar
  37. Kaestner S, Schroth I, Deinsberger W, Joedicke A, Boeker DK. Verzögernd auftretende Liquorfisteln. In: Schmelzle R, editor. Schädelbasischirurgie. Damaskus: Al-Budoor; 1998. p. 199–201.Google Scholar
  38. Kern RC, Quinn E, Rosseau G, Farbman AI. Posttraumatic olfactory dysfunction. Laryngoscope. 2000;110:21–110.CrossRefGoogle Scholar
  39. Kessel FK. Eingriffe an den Hirnnerven. In: Breitner’s Chirurgische Operationslehre, Band I. Wien: Urban und Schwarzenberg; 1955. p. 228–30.Google Scholar
  40. Kobayashi M, Costanzo RM. Chemical senses. Oxford J. 2009;34(7):573–80.Google Scholar
  41. Kuppermann N, Holmes JF, Dayan PS, et al. Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. Lancet. 2009;374:1160–70.CrossRefPubMedGoogle Scholar
  42. Lakke JP. Superior orbital fissure syndrome. Report of a case caused by local pachymeningitis. Arch Neurol. 1962;7:289–300.CrossRefPubMedGoogle Scholar
  43. Lanz J, Wachsmuth W. Praktische Anatomie. Heidelberg: Springer; 1955. 1. Aufl.CrossRefGoogle Scholar
  44. Lega BC, Danish SF, Malhotra NR, Sonnad SS, Stein SC. Choosing the best operation for chronic subdural hematoma: a decision analysis. J Neurosurg. 2010;113(3):615–21.CrossRefPubMedGoogle Scholar
  45. Lenzi GL, Fieschi C. Superior orbital fissure syndrome. Eur Neurol. 1977;16:23–30.CrossRefPubMedGoogle Scholar
  46. Levin HS, High WM, Eisenberg HM. Impairment of olfactory recognition after closed head injury. Brain. 1985;108:579–91.CrossRefPubMedGoogle Scholar
  47. Levin LA, Beck RW, Joseph ME, Seiff S, Kraker R. The treatment of traumatic optic neuropathy: the International Optic Nerve Trauma Study Group. Ophthalmology. 1999;106(7):1268–77.CrossRefPubMedGoogle Scholar
  48. Lewin W. The managment of head injuries. London: Bailliére, Tindall und Cassell; 1966.Google Scholar
  49. Lewin W. Cerebrospinal fluid rhinorrhoe in nonmissile head injuries. Clin Neurosurg. 1974;12:237.CrossRefGoogle Scholar
  50. Lewis AI, Tomsick TA, Tew JM Jr. Management of 100 consecutive direct carotid cavernous fistulas. Neurosurgery. 1995;36:239–44.CrossRefPubMedGoogle Scholar
  51. Loew F, Pertuiset B, Chaumier EE, Jaksche H. Traumatic, spontaneous and postoperative CSF rhinorrhea. Adv Tech Stand Neurosurg. 1984;11:169–207.CrossRefPubMedGoogle Scholar
  52. Manson P, French J, Hoopes J. Managment of midfacial fractures. In: Georgiade N, Georgiade G, Riefkohl R, Barwick W, editors. Essentials of plastic maxillofacial and reconstructive surgery. Baltimore: Williams and Wilkins; 1987.Google Scholar
  53. Markwalder T. Chronic subdural hematomas: a review. J Neurosurg. 1981;54:637–45.CrossRefPubMedGoogle Scholar
  54. Markwalder TM, Seiler RW. Chronic subdural hematomas: to drain or not to drain. Neurosurgery. 1985;16:185–8.CrossRefPubMedGoogle Scholar
  55. Maroon J, Kennerdell J. Surgical approaches to the orbit. Indications and techniques. J Neurosurg. 1984;60(6):1226–35.CrossRefPubMedGoogle Scholar
  56. McGee EE, Cauthen JC, Bracken CE. Meningitis following acut traumatic cerebrospinal fistula. J Neurosurg. 1970;33:312–6.CrossRefGoogle Scholar
  57. Meerhoff et al. European Federation of the Neurological Societies EFNS guideline; 2000.Google Scholar
  58. Mijzen EJ, Jacobs B, Aslan A, Rodgers MG. Propofol infusion syndrome heralded by ECG changes. Neurocrit Care. 2012;17(2):260–4.CrossRefPubMedGoogle Scholar
  59. Mincy JE. Posttraumatic cerebrospinal fluid fistula of the frontal fossa. J Trauma. 1966;6(5):618–22.CrossRefPubMedGoogle Scholar
  60. Mullan S. Treatment of carotid cavernous fistulas by cavernous sinus occlusion. J Neurosurg. 1979;50:131–44.CrossRefPubMedGoogle Scholar
  61. Natori Y, Rhoton AL. Microsurgical anatomy of the superior orbital fissure. Neurosurgery. 1995;36(4):762–75.CrossRefPubMedGoogle Scholar
  62. Neidhardt O. Kraniofaziale und frontobasale Schädelverletzungen Retrospektive Nachuntersuchung, MKG-Klinik-Kantonspital Luzern Dissertation, Universität Basel; 2002.Google Scholar
  63. O Brian MD, Reade PC. The management of dural tear resulting from midfacial fracture. Head Neck Surg. 1984;6:810.CrossRefGoogle Scholar
  64. Ommaya AK. Spinal fluid fistulae. Clin Neurosurg. 1976;23:363–92.CrossRefPubMedGoogle Scholar
  65. Paillas JE, Pellet W, Demard F. Osteomeningeal fistulas of the base of the skull with leakage of cerebrospinal fluid. J Chir (Paris). 1967;94(4):295–316.Google Scholar
  66. Parkinson D. Carotid cavernous fistula: direct repair with preservation of the carotid artery. Technical note. J Neurosurg. 1973;38:99–106.CrossRefPubMedGoogle Scholar
  67. Probst C. Frontobasale Verletzungen. Bern: Huber; 1971.Google Scholar
  68. Probst C. Neurosurgical aspects of frontobasal injuries with cerebrospinal fluid fistulas: experience with 205 operated patients. Akt Traumatol. 1986;16(2):43–9.Google Scholar
  69. Probst C, Tomaschett C. The neurosurgical treatment of traumatic fronto-basal spinal fluid fistulas (1982–1986). Akt Traumatol. 1990;20(5):217–25.Google Scholar
  70. Prolo DJ, Hanbury JW. Intraluminal occlusion of a curated carotid sinus fistula with a balloon catheter: technical note. J Neurosurg. 1971;35:237–42.CrossRefPubMedGoogle Scholar
  71. Proskynitopoulos PJ, Stippler M, Kasper EM. Post-traumatic anosmia in patients with mild traumatic brain injury (mTBI): a systematic and illustrated review. Surg Neurol Int. 2016;7:S263–75.CrossRefPubMedPubMedCentralGoogle Scholar
  72. Reden J, Mueller A, Mueller C, et al. Recovery of olfactory function following closed head injury or infection of the upper respiratory tract. Arch Otolaryngol Head Neck Surg. 2006;132:265–9.CrossRefPubMedGoogle Scholar
  73. Rengachary SS. Cranial nerve examination in neurosurgery. In: Wilkins RH, Rengachary SS, editors. Neurosurgery, vol. 1. 2nd ed. New York: Mc Graw-Hill; 1996. p. 67.Google Scholar
  74. Rengachary SS, Ellenbogen RG. Principles of neurosurgery. 2nd ed. Elsevier: Mosby; 2004. p. 301–68.Google Scholar
  75. Rhoton AL. The orbit. Neurosurgery. 2002;51(4 Suppl):303–34.Google Scholar
  76. Roberts I, Sydenham E. Barbiturates for acute traumatic brain injury. Cochrane Database Syst Rev. 2012;(12).Google Scholar
  77. Roton AL, Michio UM. Microsurgical anatomy of the region of tentorial incisura. In: Wilkins RH, Rengachary SS, editors. Neurosurgery, vol. 1. 2nd ed. New York: Mc Graw-Hill; 1996. p. 899.Google Scholar
  78. Russell T, Cummins BH. Cerebrospinal fluid rhinorrhea 34 years after trauma: a case report and review of the literature. Neurosurgery. 1984;15(5):705–6.CrossRefPubMedGoogle Scholar
  79. Sakas DE, Beale DJ, Ameen AA, Whitwell HL, Whittaker KW, Krebs AJ, et al. Compound anterior cranial base fractures: classification using computerized tomography scanning as a basis for selection of patients for dural repair. J Neurosurg. 1998;88(3):471–7.CrossRefPubMedGoogle Scholar
  80. Schaller B. Das Schädelhirntrauma - Neue pathophysiologische und therapeutische Gesichtspunkte. Swiss Surg. 2002;8:123–37.CrossRefPubMedGoogle Scholar
  81. Schick B, Weber R, Mosler P, Keerl R, Draf W. Long-term follow-up of fronto-basal dura-plasty. HNO. 1997;45(3):117–22.CrossRefPubMedGoogle Scholar
  82. Schmidek HH, Sweet WH. Operative neurosurgical techniques, vol. I. Philadelphia: Saunders; 1988.Google Scholar
  83. Sepehrnia A. Preservation of the olfactory tract in bifrontal craniotomy for various lesions of the anterior cranial fossa. Neurosurgery. 1999;44(1):113–7.CrossRefPubMedGoogle Scholar
  84. Serbinenko FA. Balloon catheterization and occlusion of major cerebral vessels. J Neurosurg. 1974;41:125–45.CrossRefPubMedGoogle Scholar
  85. Shapiro R, Janzen AH. The normal skull. Variations in the shape of the superior orbital fissure. Anat Anz. 1960;165:55–6.Google Scholar
  86. Sharma PK, Malhotra HK, Tiwari SP. Variations in the shape of the superior orbital fissure. Anat Anz. 1988;165:55–6.PubMedGoogle Scholar
  87. Shields J. Diagnosis and management of orbital tumours. Philadelphia: Saunders WB; 1989. p. 8–10.Google Scholar
  88. Spetzler RF, Zabramski JM. Cerebrospinal fluid fistula. Contemp Neurosurg. 1986;8:1–7.Google Scholar
  89. Spetzler RF, Herman JM, Beals S, Joganic E, et al. Preservation of olfaction in anterior craniofacial approaches. J Neurosurg. 1993;79(1):48–52.CrossRefPubMedGoogle Scholar
  90. Sprick C. Komplikationen bei und nach neurochirurgischen Eingriffen beim Schädel-Hirn-Trauma. In: Bock W, Schirmer J, editors. Komplikationen bei neurochirurgischen Eingriffen Zuckschwerdt. Bern: München; 1988.Google Scholar
  91. Stiell IG, Wells GA, Vandemheen K, et al. The Canadian head CT rule for patients with minor head injury. Lancet. 2001;357:1391–6.CrossRefPubMedGoogle Scholar
  92. Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet. 1974;2:81–4.CrossRefPubMedGoogle Scholar
  93. Wade DT, King NS, Wenden FJ, Crawford S, Caldwell FE. Routine follow up after head injury: a second randomised controlled trial. J Neurol Neurosurg Psychiatry. 1998;65:177–83.CrossRefPubMedPubMedCentralGoogle Scholar
  94. Watson B. Treatment of basal skull fractures with and without cerebrospinal fluid fistulae. J Neurosurg. 1967;26:57–61.CrossRefGoogle Scholar
  95. Yennet B. Outcome after severe head injury. In: Reilly PL, Bullock R, editors. Head injury, pathophysiology and management. 2nd ed. New York: Hodder Arnold; 2005. p. 441–61.Google Scholar
  96. Young YL, Yi HJ, Lee SK, et al. Posttraumatic anosmia and ageusia: incidence and recovery with relevance of the hemorrhage and fracture on the frontal base. J Korean Neurosurg Soc. 2007;42:1–5.Google Scholar
  97. Yousem DM, Geckle RJ, Bilker WB, Kroger H, Doty RL. Posttraumatic smell loss: relationship of psychophysical tests and volumes of the olfactory bulbs and tracts and the temporal lobes. Acad Radiol. 1999;6:264–72.CrossRefPubMedGoogle Scholar
  98. Zachariades N. The superior orbital fissure syndrome. Review of the literature and report of a case. Oral Surg Oral Med Oral Pathol. 1982;53:237–40.CrossRefPubMedGoogle Scholar
  99. Zachariades N, Vairaktaris E, Papavassiliou D, Triantafyllou D, Mezitis M. Orbital apex syndrome. Int J Oral Maxillofac Surg. 1987;16:352–4.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Karl Kothbauer
    • 1
  • Mariel Laak ter Poort
    • 2
    Email author
  • Abolghassem Sepehrnia
    • 3
  1. 1.Division of Neurosurgery, General and Pediatric NeurosurgeryUniversity/Basel, Luzerner KantonsspitalLuzernSwitzerland
  2. 2.Maastricht University Medical CenterMaastrichtNetherlands
  3. 3.Neuro Spinal Surgery Centre, Craniofacial-Skullbase Center, Hirslanden Clinic - St. AnnaLuzernSwitzerland

Personalised recommendations