Surgical treatment of frontobasal injury with CSF leak-our experience

Česká verzia

Authors: Ondřej Teplý; Jiří Fiedler; Vladimír Přibáň
Authors place of work: Dept. Of Neurosurgery, Fakulty of Medicíně, Masaryk University ; Department of Neurosurgery, Hospital České Budějovice, a. s. ; Neurochirurgická klinika LF MU a FN Brno ; Neurochirurgické oddělení Nemocnice České Budějovice, a. s.
Published in the journal: Úraz chir. 18., 2010, č.2

Summary

Aim:
Evaluation of influence of anterior skull base surgery timinig on results and complications rate from retrospective analysis in our institution.

Material and Methods:
There were 32 patients operated on for anterior skull base injury in period 2006-2009 in our department. Mostly men, average age was 40.7 y. In seven patients was surgery postponed from various reasons and so they were excluded from the study. Anterior skull base fracture was combined with intracranial injury in most patients. Diagnostics con-sisted in case history, clinical and biochemical examination, plain radiography, CT and someti-mes radionuclide cisternography.

Results:
25 patients were operated on early for anterior skull base injury. 10 patients had no combined intracranial injury. Time from injury to surgery was 5, 6 days. 15 patients had combined intracranial injury (intracerebral, subdural and or epidural hematoma). Interval between injury and surgery was 12, 6 days. Water-tight closure with stop of CSF (Cerebrospinal Fluid) leak was succesful in 90 % patients after acute surgery with the use of bifrontal craniotomy. Suplementary procedures: endonasal endoscopy (2x), revision of insufficient duroplasty (1x) led to complete efficacy. GOS corelated with initial GCS (and presence of intracranial injury). Deferral of surgery was associated with higher rate of inflammatory complications.

Conclusion:
On the basis of our retrospective study and in conformity with literature we recommend acute surgery in anterior skull base injury with CSF leak. The exclusion is the patient in critical status (polytrauma). Postponed revision is associated with unacceptable high rate of inflammatory complications.

Key Words:
Cerebrospinal Fluid Rhinorrhea, Skull Fractures, Central Nervous System Bacterial Infections.

Zdroje

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Štítky

Surgery Traumatology Trauma surgery

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Článok vyšiel v časopise

Trauma Surgery

2010 Číslo 2

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