Zugänge zur Schädelbasis und interdisziplinäre Versorgung von Schädelbasisfrakturen

Basal skull fractures (BSFs) are serious injuries requiring a great deal of force that mainly occur in the context of extensive trauma. With 19–21% of all serious head injuries, they nevertheless account for a significant proportion. Due to the close positional relationships and the large number of sensitive anatomic structures, a wide variety of injury patterns and functional limitations result, depending on the position and course of the fracture. This usually requires an interdisciplinary approach, which can include the fields of oral and maxillofacial surgery, neurosurgery, otorhinolaryngology, ophthalmology, and radiology. To date, there is no general, standardized classification of BSFs. Frequently occurring fractures of the anterior skull base are primarily classified according to Escher. Most BSFs can be treated conservatively. Particular attention must be paid to the occurrence and evidence of liquorrhea and the risk of meningitis. If there is an indication for surgical treatment, there are also a number of possible approaches, with the bicoronary approach (bow incision) still playing the most important role. Depending on the fracture pattern and the need for treatment, other approaches can be selected and combined in close consultation with all departments. Intraoperative 3D imaging using cone beam CT is also becoming increasingly important, as it offers an immediate opportunity to check and correct the surgical treatment.