24 Neurosurgery MCQs Answers

Answer: b, c

Skull fractures are classified according to whether the skin overlying the fracture is intact (closed) or disrupted (open or compound), whether there is a single fracture line (linear), several fractures radiating from a central point (stellate), or fragmentation of the bone (comminuted), and whether the edges of the fracture line had been driven below the level of the surrounding bone (depressed) or not. Simple skull fractures (linear, stellate, or comminuted nondepressed) require no specific treatment. They are, however, potentially serious and can be fatal if they cross major vascular channels in the skull, such as the groove of the middle meningeal artery or the dural venous sinuses.

Depressed skull fractures often require surgery to elevate the depressed bone fragments. If there are no adverse neurologic signs and the fracture is closed, repair may be done electively. Basal skull fractures involve the floor of the calvarium. Bruising may occur about the eye (raccoon sign) or behind the ear (Battle sign), suggesting a fracture involving either the anterior or middle fossa, respectively. Any associated cerebrospinal fluid (CSF), rhinorrhea, or otorrhea should be treated expectantly.

Traumatic CSF leaks typically stop within the first 7 to 10 days. Should a leak persist, lumbar CSF drainage can be implemented to seal the leak by lowering CSF volume and intracranial pressure. If this therapy fails, surgical exploration and oversewing of the defect with a facial patch graft is indicated. Less than 5% of patients actually require surgical repair. Prophylactic antibiotics are no longer used since prospective studies have failed to demonstrate any significant benefit from their use.

Category: Surgery MCQs