British journal of neurosurgery
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Review Case Reports
Ring fracture of the skull base: case report and review of the literature.
Ring fractures of the skull base are rare and have hitherto been regarded as invariably fatal injuries. They are difficult to diagnose, as routine radiographs of the head and spine are usually normal. Increasing use of computerized tomography in the evaluation of head and neck injuries may, however, lead to an increased frequency of diagnosis of this injury. We present a case of such a fracture where the patient survived with a generally good neurological recovery.
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The objective of this study was to understand the biomechanics in age-related primary traumatic brain injuries (TBI) causing initial severity and secondary progressive damage and to develop strategy reducing TBI outcome variability using biomechanical reconstruction to identify types of causal mechanisms prior to clinical trials of neuro-protective treatment. The methods included the explanation of TBI biomechanics and physiopathological mechanisms from dual perspectives of neurosurgery and biomechanical engineering. Scaling of tolerances for skull failure and brain injuries in infants, children and adults are developed. ⋯ In humans this has failed, because the animal model received biomechanically controlled TBI and humans did not. Clinical similarities of human TBI patients do not necessarily predict equivalent biomechanics because such trauma can be produced in various ways. We recommend 'reverse engineering' for in-depth reconstruction of the TBI injury mechanism for qualitative diagnoses and reduction of outcome variability.