EARLY AND LATE COMPLICATIONS AFTER SEVERE CRANIOCEREBRAL TRAUMA - CHRONIC SUBDURAL-HEMATOMA HYGROMA, CAROTID ARTERY-CAVERNOUS SINUS FISTULA, BRAIN-ABSCESS, MENINGEAL INFECTION AND POSTTRAUMATIC HYDROCEPHALUS

A group of 318 patients suffering from severe head injury, 51 of whom died of their (head) injury, is reviewed. A small contusional cerebral haemorrhage had occurred in 50.6 %, and 30 % had had basal skull frac tures. In the entire group, 2.8 % developed posttraumatic hydrocephalu s. Shunt implantation was necessary between the 11th and 123th posttra umatic days (mean 52th). All patients with inflammatory problems, e.g. meningitis or intracranial abscess, developed posttraumatic hydroceph alus. In 10 of the 12 patients with hygromas, an operative procedure w ith bur hole trepanation was necessary. Half of the patients with hygr omas were polytraumatized but only 25.85 % of the entire group. Two pa tients in the group and a further 49 patients with chronic subdural ha ematomas were operated on by a bur hole trepanation and appropriate dr ainage for several days. In 2 cases the development of the chronic sub dural haematoma had been documented by CAI. All patients with frontoba sal skull fractures were operated on by a transethmoidal approach only the 1st day. Only 2 of the laterobasal skull fractures needed an oper ation. One of these caused was by a pneumocephalus. In 0.9 % of the pa tients an intracranial abscess was present; these all had a basal skul l fracture, 1 after gunshot injury. Among the patients with basal skul l fractures 3.1 % developed carotid artery-cavernous sinus fistula. On e of these three fistulas has been documented as yielding to spontaneo us closure. After reangiography for balloon occlusion an aneurysm was found. Following primary operation, 2.5 % of patients required revisio n operation because of renewed bleeding. The posttraumatic treatment o f the complications is discussed.