Temporal lobe injury in temporal bone fractures

Objective: To determine the incidence of intracranial injury, specifically in the temporal lobe, in patients with longitudinal fractures of the tempor al bone. Design: Prospective inception cohort. Settings: University of Maryland Division of Otolaryngology-Head and Neck S urgery and the Maryland Shock Trauma Center, Baltimore. Patients: Twenty-seven consecutive patients with unilateral or bilateral te mporal bone fractures. Main Outcome Measures: Evaluation of temporal bone and intracranial trauma using computed tomography (CT) and magnetic resonance imaging (MRI). Results: Of the 27 patients enrolled in the study, 12 had the complete batt ery of MRI, CT, and physical and audiological examinations. In all 12 patie nts, MRI demonstrated adjacent middle cranial fossa meningeal enhancement. Results of non-contrast-enhanced CT and MRI demonstrated ipsilateral tempor al lobe contusions in 6 of the 13 fractures for an overall incidence of 46% . In addition, MRI demonstrated 4 cerebral contusions not seen in the resul ts of non-contrast-enhanced CT. Conclusions: While high-resolution CT remains the criterion standard for ev aluation of temporal bone fractures, MRI revealed a higher incidence of rel ated temporal lobe injuries. Magnetic resonance imaging data may be valuabl e in preoperative evaluation of patients who require surgical intervention through a middle cranial fossa approach to document pre-existing injury and potential morbidity before retraction of the middle cranial fossa dura mat er and temporal lobe.