Skull-base trauma: neurosurgical perspective

Trauma to the cranial base can complicate craniofacial injuries and lead to significant neurological morbidity, related to brain and/or cranial nerve injury. The optimal management involves a multidisciplinary effort. This article provides the neurosurgeon's perspective in management of such trauma using a 5-year retrospective analysis of patients sustaining skull-base trauma. The salient features of anterior and middle skull-base (temporal bone) trauma are summarized, and the importance of frontal basilar trauma as well as brain injury is evident. With these injuries, all cranial nerves (except 9 to 12) are at risk; the olfactory nerve and the facial nerve are the first and second, respectively, to sustain injuries. This retrospective analysis provides a better understanding of cranial base trauma and its management. It emphasizes the multifaceted nature of such trauma and the need to recognize anterior skull-base complications, including cerebrospinal fluid leak and brain injury.