Classification

On the basis of experience of leading neurosurgical clinics a unified classification of CCT was made up. The nature and degree of damage of the brain lie at its basis as in most cases these very criteria determine the clinical course, medical tactic and prognosis. All modern classifications are based on the classification suggested as early as in 17th century by a French scientist Jacques Petit who distinguished concussion of the brain (comotio cerebri), contusion of the brain (contusio cerebri), and compression of the brain (compressio cerebri). The classifications were changed and complemented which extended the primary classification proceeding from the principal theses of modern medicine.

Depending on the nature of damage of outer integument of the skull and possibility of infecting the content of its cavity the two main types of trauma are distinguished:

1. Closed CCT (disturbances of the integrity of the calvarium are absent, or there are superficial wounds of soft tissues without the damage of aponeurosis, including those in the presence of fractures of the calvarial bones).

2. Open CCT (damages of soft tissues of the calvarium accompanied by damage of aponeurosis; fractures of the bones of the calvarius which pass through air sinuses, and fractures accompanied by liquorrhea). In this type of trauma there is a real threat of emerging of infectious complications from the side of the content of the cranial cavity.

Closed CCT make on average 70-75% of all CCT. Open CCT depending on damage of the last barrier on the way to the brain - dura mater - are divided as follows:

1. Penetrating CCT (there is a disturbance of the integrity of the dura mater including fractures of the calvarial bones accompanied by liquorrhea).

2. Nonpenetraiting (the integrity of the dura mater is safe).

By the presence of concomitant damages one distinguishes the followings forms of CCT:

1. Isolated (extracranial damages are absent).

2. Associated CCT (a combination of craniocerebral trauma with mechanical damages of other parts of the body. At that, depending on the area of the damage, one can distinguish cranioabdominal, craniothoracic, craniofacial, craniovertebral, cranioskeletal traumas and others).

3. Combined CCT (combination of craniocerebral trauma with nonmechanical damages: chemical, radial, toxic, thermal damages).

Depending on the type and nature of the damage the following clinical forms of CCT are distinguished:

1. Concussion of the brain.

2. Contusion of the brain:

• mild;

• moderate;

• severe (sometimes, depending on the prevailing symptomatology, one distinguishes extrapyramidal, diencephalic, mesencephalobulbar, cerebrospinal forms).

3. Compression of the brain:

• compression without contusion of the brain;

• compression with contusion of the brain.

4. Diffuse axonal injury of the brain.

5. Compression of the head.

Some scientists suggest to distinguish also the diffuse (concussion, diffuse axonal injury) and focal (contusion, compression) damages of the brain. However, this classification has not been widely spread.

Depending on the degree of severity one distinguishes the following CCT:

- mild (concussion of the brain and mild contusion of the brain);

- moderate (moderate contusion of the brain, chronic and subacute compression of the brain);

- severe (severe contusion of the brain, acute compression of the brain, diffuse axonal injury).

A particular group CCT is made up by gunshot wounds, many of which are penetrating and distinguish themselves by variety depending on the type of the damaging shell, the type of gun, the trajectory of the canal etc. (Fig. 1). Gunshot wounds have their separate classification:

• blind (35,8%):

- simple;

- segmental;

- radial;

- diametral perforating (4,5%):

- segmental;

- diametral;

• tangential (45,9%);

• ricochet (11,1%)

Fig. 1. Types of gunshot wounds of the head: 1 - simple; 2 - segmental; 3 - radial; 4 – diametral

Date: 2015-01-02; view: 1095