[Surgical treatment of cranioorbital injuries combined with brain trauma].

Cranioorbital injuries (COI) are combined with brain trauma in 45-53% of patients and in 21--24% of cases require surgical treatment. Aim of this study was to evaluate the results of surgical treatment of patients with COI in acute period of traumatic brain injury (TBI). Among 4078 patients with TBI admitted to neurosurgical department of Sklifosovsky Institute of Emergency Medicine, 428 (10,5%) had COI. In acute period of TBI reconstructive procedures were performed in 158 (36,9%) cases. In 78 (49,4%) patients reconstructive surgical procedures were done within 48 hours after injury, in 35 (22,2%) of them simultaneously with neurosurgical operation. In 53 (33,5%) patients underwent surgical treatment in 1 week after trauma or later. Majority of procedures were reconstructive operations with reposition and rigid fixation of fractured bones using different implants. Overall mortality in patients with COIl was 5,3%, postoperative mortality--4,6%. Postoperatively position of the eyeball was restored totally or partially in 127 (97,7%), oculomotor disorders regressed in 132 (98,5%) patients. Obtained results of surgical treatment of COI in acute period of TBI demonstrate high effectiveness and safety of active surgical tactics. Application of modern diagnostic methods and interdisciplinary approach in management of COI in early period after trauma provide good functional and cosmetic results.

[Plastic closure of anterior fossa with simultaneous reconstruction of superior and middle facial zones].

The article describes surgical treatment of a patient with traumatic brain injury combined with anterior fossa defect, CSF leak, bony fractures of superior and middle facial zones. Multidisciplinary surgical team including neurosurgeon, maxillofacial surgeon and ophthalmologist performed single-step operation which consisted of skull base defect closure, cranialization of frontal sinus and reconstruction of its anterior wall by titanium mesh, reposition and fixation of bony fragments of nasoorbital complex, maxilla, surgical fixation of occlusion by cortical screws. The surgery resulted in cessation of CSF leak, restoration of orbital geometry which lead to regression of diplopia and oculomotor disorders. Cosmetic defect was eliminated. This case report demonstrates high effectiveness of multidisciplinary approach in surgical treatment of complex craniofacial injuries.