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Two current approaches to the ergometric evaluation of the impact strength that lead to skull fracture are described. Within each of them, the features of particular techniques, typical expert errors, ways and means of preventing them are analyzed. Quantitative data on the contribution of various initial parameters (fracture type, age, bone thickness, skull radius of curvature, body weight, height, etc.) to the result of computational diagnostics are presented.

The authors report a clinical case of the fracture of the base of the skull with the concomitant damage to the sigmoid sinus, jugular vein, and internal carotid artery in the temporal bone pyramid. The injury was associated with massive bleeding from the external acoustic canal that resulted in the death of the patient.

The authors described the variants of initial surgical d-bridement on the basis of experience of treatment of 183 patients of multistaged treatment program.

It is important to improve the medical care system and treatment of victims, introduce new methods of treatment and attract the multidisciplinary specialists in the cases of multitrauma. An integrated approach is required for the identification of different character and severity of multiple craniofacial injuries and the development of rational surgical strategy on this base. Different scales such as AIS, CRIS, ISS, PTS, TRISS, TRISSCAN, CRAMS et.al, were created abroad. Another approach to medical strategy was developed in the department of military surgery of Kirov Military Academy in the late nineties. It was based on investigating of possibilities of surgical strategy optimization by application of objective evaluation of the severity of injuries (military surgery--SP, SG, SS). Given treatment strategy of victims with multiple craniofacial trauma resulted in double reduction of quantity of suppurative and septic complications (from 10.5% to 4.1%). It gave the possibility to reduce the lethality from 6.4% to 4.0%. At the same time a hospital stay was shortened and the strategy allowed obtaining satisfactory functional results of treatment and avoiding reinterventions for removal of posttraumatic facial deformations.

The paper presents main types of surgically relevant posttraumatic lesions in 4136 patients with skull vault as well as skull base defects, craniofacial deformities, recurrent CSF leaks, arterio-venous fistulas, aneurysms and pseudoaneurysms etc. Classification of TBI sequelae and complications as well as its clinical course grading is presented. The use of modern neuroimaging techniques for studying pathophysiologic mechanisms and complications of TBI has been demonstrated. Special emphasis was given to minimally invasive and reconstructive surgery; computer modeling with subsequent full-copy stereolitographic laser implant setup was shown which is of great importance in cases of large and complex skull base and craniofacial deformities. Patient selection for transcranial and endonasal CSF leak closure techniques was justified. Treatment of post-traumatic vascular injuries using Serbinenko balloon-catheters as well as modern techniques such as stents, coils and embolization has been demonstrated.

One hundred and forty (140) medicolegal reports were analyzed in cases of non-lethal trauma of the head in children and teenagers. The specificity of the clinical pattern related with the anatomic-and-physiological peculiarities of child's body was defined. The forensic-medical expertise in such damages needs an elaboration of diagnostic criteria (e.g. an interim stage in craniocerebral trauma) that would be valuable both for medico-legal experts and for neurologists; besides, there is also a need in using the modern methods of neuro-visualization.

A total of 100 patients with combined injuries of the organ of vision and eye appendages, inflicted in peacetime and under war conditions, were examined. The clinical picture of combined injuries in the wounds inflicted at the battlefield (gunshot and resultant from mine explosions) and of traffic, communal, criminal, and occupational injuries was studied using traditional ophthalmological and common clinical instrumental methods of examination. Common regularities of the traumatic process were revealed in combined injuries: mutual aggravation of injuries to the eye and its appendages, a considerable incidence of bilateral injuries, and simultaneous impacts of several damaging factors. The most unfavorable prognosis as regards visual functions in the group observed was for patients with war injuries, particularly those caused by mine explosions.

The paper deals with the diagnostic potentialities of using various techniques in the wounded persons with arms-induced brain injuries. The diagnosis of arms-induced wounds of the skull and brain must be comprehensive and made concurrently with therapeutical measures. The instrumental methods must be applied to the extent accessible for the given wounded person and a study should be stopped immediately after a diagnosis is established.

A scheme of the diagnosis of subarachnoidal hemorrhages in patients with closed craniocerebral injury is offered. It provides for distribution of hemorrhages according to the cause, intensity and stages. The results were investigated in 595 patients. The use of the scheme for diagnosis in public health is likely to promote the accuracy of diagnosis and more goal-oriented treatment.

Analysis of the victims of the earthquake in Armenia made it possible to distinguish a form of trauma, unique in biomechanics and pathogenesis, which was not described earlier, namely, prolonged compression of the head (PCH). Its clinical picture is characterized by superimposition and mutual aggravation of general organismic, general brain, cerebral and extracerebral focal symptomatology. Variants of the relations of the syndrome of prolonged compression of the soft tissues of the head and the craniocerebral damages proper are described. A detailed CT characterization of PCH is given. The principles of stage treatment of victims and the indications for compelled nonoperative and surgical tactics in PCH are suggested for the first time.

An analysis of findings of complex clinical examinations and treatment of 46 patients with open cranio-cerebral traumas was made. Specific features of clinical manifestations are shown which are substantially different from closed cranio-cerebral traumas. They are primary infection of the cranio-cerebral wound, haemorrhage, liquorrhea, foreign bodies in the cranial cavity. Curative measures for the first aid, indications and contraindications for early surgical treatment, its technique are elucidated.

It is shown that in the recent 2 decades the incidence of craniocerebral trauma increased from 4.8 to 7.2% among old-aged individuals and from 53 to 72% in the group of patients over 60. The dynamics of changes in the clinical course of mild craniocerebral trauma in 21% of old-aged patients were marked by secondary acute cerebral circulatory disorders which often led to a fatal outcome. Mortality rate in craniocerebral trauma at old age was 52.3%.

The symptomatology and results of treatment of 26 patients with traumatic hematomas of the posterior cranial fossa (PCF) are analysed. The hematomas were verified on operation in 19 patients and on postmortem examination in the other patients. It is concluded that the diagnosis of PCF hematomas is based on a combination of signs: cervico-occipital mechanism of the trauma, fracture of the occipital bone, cerebello-stem symptomatology, and acute hydrocephalus. The formation of trephination openings on the line of the fracture of the occipital bone is considered expedient in the presence of the above listed signs of affection of the PCF structures and the absence of computer tomography. Tests for induced stem potentials must also be included in the diagnostic complex. Total lethality was 53.8%, surgical lethality--25%.

Epidural hematomas of the anterior cranial fossa are a relatively rare localization of intracranial hemorrhage. Hematomas of this localization show a peculiar course and clinical manifestation. By the character of clinical manifestations, course of the injury, results of surgical treatment two groups of patients were distinguished: patients with isolated hematomas of the frontal region characterized by a paucity of clinical manifestations and patients with epidural hematomas of the frontal region associated with other intracranial lesions and are characterized by a grave course and high lethality.

The problem of differential diagnosis of head occipital lesions in different mechanisms of trauma is discussed. Statistical method of data processing is suggested. This method combined with common methods increase the scientific level of expert conclusions.

The structure of the diagnosis of craniocerebral trauma in the acute period was elaborated in conformity with its common clinical classification. The authors substantiate the necessity for supplementing the general nosological characteristics of the injuries to the skull and brain with a specification of all anatomical and principal functional components of the trauma, which are listed in order of their importance for the therapeutic policy and the outcomes.

The work analyses the specific features of the clinical picture, diagnosis, and treatment of craniocerebral injury because of 7 car accidents (225 patients) and in common accidents of everyday life (210 patients). Craniocerebral injury in car accidents is very severe (high incidence of massive and multiple contusions of the brain, fractures of the skull bones, intracranial hematomas) and is often combined with injury to the viscera and bones. Thorough clinical and neurological examination, x-ray of the skull, echoencephalography, cerebral angiography, and trephination of the skull help to disclose and identify exactly the character of the cerebral damage. The therapeutic complex in craniocerebral injury because of car accidents includes measures of intensive therapy and, if indicated, surgical intervention. Traumatism occurring as the result of car accidents is characterized by coarser cerebral functional defects and graver invalidism of patients in contrast to accidents of everyday life.

In order to reveal certain quantitative criteria on the skull basis deformities resulting from an injuring agent effect, an experimental investigation has been performed using the holographic interferometry method. Interferograms are registrated according to the scheme offered by Yu. N. Denisyuk at a gradual mechanical loading of the skull by means of a special device. A complicated picture of the skull basis deformity has been revealed under the effect of a successively increasing loading. When the external loading is comparatively small, a slight deformity of some bones appears and their dislocations regarding each other are distinctly seen. When the loading is as great as 90 kg (900 N), the mutual dislocation of the bones is stopped and a solid formation is resulted. If the loading is further increased, the curve of the whole skull basis is produced along the line passing through the foramen occipitale magnum region. The phenomena described correspond to an elastic skull deformity. Cracks and fractures begin forming when the resources of the mutual dislocation of the osseous fragments and the elastic deformity of separate bones are completely exhausted (in the experiments performed--at the loadings of 100 kg, that is 1,000 N and more). The greatest strain is observed in the area of the Turkish saddle, wings of the os sphenoidal, apices of the tample bone pyramids, that corresponds to clinical data on localization of fractures.

The authors studied the informative value of clinical signs of craniocerebral trauma (CCT) in relation to the prediction of different categories of recovery. Using a package of applied programmes MEDSTAT-85 a clinical pool of the findings about the status of 302 patients examined by a uniform technique was subjected to clinical analysis. The optimal set of clinical indicators for predicting different categories of recovery in the first 24 hours after the CCT with an average accuracy of 80% is described.

The informativeness of clinical indicators for predicting lethal and favourable outcomes during the first 24 hours after a head trauma has been investigated. A pool of clinical findings about the status of 302 patients examined according to a uniform technique has been analyzed using a packet of the MEDSTAT-85 software. The authors present an optimal set of clinical signs for predicting fatal and favourable outcome within the first 24 hours after the trauma with an 83% probability rate.

Of 740 patients with severe contusions of the brain a group of patients with expansion of the contusion foci was differentiated. In 31.8% of the patients, the contusion foci were localized in the polar-basal portions of the frontal and/or temporal lobes and in 2.5% of patients on the convex surface of the large hemispheres and penetrated into the white matter. Clinical variants of the course of expansion processes of contusion foci are described. The craniographic, echoencephalographic and angiographic characteristics of the damaged brain are also presented. Expansion of contusion foci of the large hemispheres is documented pathomorphologically. A correlation was found between the manifestations of expansion of the contusion foci and their structural characteristics.

The authors analyzed the results of treating 171 patients with sequelae of brain trauma and defects in the bones of the cranial fornix. On the basis of repeated examinations disturbances of brain functions were detected in 94 patients. In the remaining cases the only reason for invalidity was the cranial bone defect. For purposes of cranioplasty different methods were used. The results of surgical treatment permit to claim that the operation of choice in closing the bone defect is cranioplasty by homobones. In alloplasty of the cranial bone defect and all the more so in homobone plasty, it is expedient to reconsider the medico-labour examination in this category of patients.