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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.

Review of literature dealing with fractures of frontal bone involving frontal sinus is presented. 3 cases of successful surgical treatment of different frontal sinus injuries are reported in the paper. The author demonstrates importance of selection of correct surgical tactics for primary reconstruction of frontal bone using craniofacial osteosynthesis. The key moment of surgical procedure is making a decision about preservation or elimination (obliteration or cranialization) of the frontal sinus which should be based on meticulous analysis of symptoms and CT data preoperatively and intraoperatively. Special attention should be paid to application of pericranial flap for closure of fractured posterior wall of the frontal sinus. Original technique of using a split pericranial pedicled flap for isolation of dura from sinus and stimulation of reparative osteogenesis is described.

The aim of study was to optimize evaluation and surgery of cranioorbital injuries in different periods after trauma. Material and methods. We analyzed 374 patients with cranioorbital injuries treated in Burdenko Neurosurgery Institute in different periods after trauma from January 1998 till April 2010. 288 (77%) underwent skull and facial skeleton reconstructive surgery within 24 hours - 7 years after trauma. Clinical and CT examination data were used for preoperative planning and assessment of surgery results. Stereolithographic models (STLM) were applied for preoperative planning in 89 cases. The follow-up period ranged from 4 months up to 10 years. Results. In 254 (88%) of 288 patients reconstruction of anterior skull base, upper and/or midface with restoration of different parts of orbit was performed. Anterior skull base CSF leaks repair, calvarial vault reconstruction, maxillar and mandibular osteosynthesis were done in 34 (12%) cases. 242 (84%) of 288 patients underwent one reconstructive operation, while 46 (16%)--two and more (totally 105 operations). The patients with extended frontoorbital and midface fractures commonly needed more than one operation--in 27 (62.8%) cases. Different plastic materials were used for reconstruction in 233 (80.9%) patients, of those in 147 (51%) cases split calvarial bone grafts were preferred. Good functional and cosmetic results were achieved in 261 (90.6%) of 288 patients while acceptable were observed in 27 (9.4%). Conclusion. Active single-stage surgical management for repair of combined cranioorbital injury in acute period with primary reconstruction optimizes functional and cosmetic outcomes and prevents the problems of delayed or secondary reconstruction. Severe extended anterior skull base, upper and midface injuries when intracranial surgery is needed produced the most challenging difficulties for adequate reconstruction. Randomized trial is required to define the extent and optimal timing of reconstructive surgery in patients with severe traumatic brain injury and craniofacial injury in acute period of trauma.

A hundred and two victims (120 reconstructive operations) with cranioorbital injuries were operated on at the N. N. Burdenko Institute of Neurosurgery in different periods after injury in 2000 to 2005. In 69 (67.6%) of the 102 patients (82 operations) bone autografts, mainly calvarial ones (61 operations in 55 victims), were used. The operations were performed, by utilizing both neurosurgical and ophthalmoplastic techniques and up-to-date craniofacial surgical procedures. The basic principle of surgical treatment for cranioorbital injuries was three-dimensional orbital anatomy restoration, such as the stabilization and repair of the orbital rim and one-stage reconstruction of the afflicted walls. Computed tomography provides main information for the efficient planning of a surgical intervention. Optimal cosmetic and functional results are attained when primary reconstructive surgery is made in the acute or early (10-14 days) periods after injury. Secondary cranioorbital reconstructive surgery may be performed in one or several steps in relation to the severity and signs of bone structural injuries and to the state of soft tissues. A bone autograft is the material of choice for repair of all portions of the cranioorbital region.

The present paper generalizes the tactical principles of the examination and treatment of patients with orbital fractures. The clinical signs of a fracture are evaluated, with emphasis laid on the significant and insignificant symptoms. Routine X-ray study is regarded as an inadequate diagnostic technique, computed tomography is presented as a basic procedure for detecting and detailing the specific features of the fracture. The cases (n = 161) are divided into 5 groups according to the types of fracture. The treatment sequence is defined, by taking into account the severity of injury. The time of reparative operations (early or late) is recommended in terms of the risk for ocular dysfunction. The principles of reparative and compensatory surgical techniques for different types of injuries, mainly by applying bony autografts and Carbotextim, are given.

Craniocerebral injuries are known to involve the visual tract in 2-5% of cases. Fifty-nine patients aged 5 to 68 with visual tract involvement in craniocerebral injury were examined in N. N. Burdenko Institute of Neurosurgery of the Russian Academy of Medical Sciences. Unilateral optic nerve involvement was found in 48 patients, involvement of the chiasm and/or both optic nerves in 11. Involvement of a single optic nerve was associated with vision acuity reduction, 30 patients becoming blind or virtually blind, and with various defects of the visual field. Traumatic injury to the chiasm manifested as a rule by the asymmetric chiasmal syndrome. Follow-up of the patients in the acute period of craniocerebral injury showed that paling of the optic disc manifested in various periods after the moment of the injury, from 3-4 days to 1 month, this depending on the localization of the injury and its distance from the posterior pole of the eye. Besides visual disturbances and ophthalmoscopic changes, oculomotor disorders were found which were caused by traumatic impairment of the oculomotor nerves (in the orbit or skull) and muscles. Transcutaneous electrostimulation of the injured optic nerves was sufficiently effective, its efficacy directly depending on the period elapsed since the injury, excepting blind or virtually blind patients.

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.