Reference : Surgical management of anterior cranial base fractures with cerebrospinal fluid fistu...
Scientific journals : Article
Human health sciences : Surgery
http://hdl.handle.net/2268/57018
Surgical management of anterior cranial base fractures with cerebrospinal fluid fistulae: a single-institution experience.
English
Scholsem, Martin [> > > >]
Scholtes, Félix mailto [Centre Hospitalier Universitaire de Liège - CHU > > Neurochirurgie >]
Collignon, Frederick [> > > >]
Robe, Pierre [Centre Hospitalier Universitaire de Liège - CHU > > Neurochirurgie >]
Dubuisson, Annie mailto [Centre Hospitalier Universitaire de Liège - CHU > > Neurochirurgie >]
Kaschten, Bruno mailto [Centre Hospitalier Universitaire de Liège - CHU > > Neurochirurgie >]
Lenelle, Jacques mailto [Centre Hospitalier Universitaire de Liège - CHU > > Neurochirurgie >]
Martin, Didier mailto [Centre Hospitalier Universitaire de Liège - CHU > > Neurochirurgie >]
2008
Neurosurgery
Lippincott Williams & Wilkins
62
2
463-9; discussion 469-71
Yes (verified by ORBi)
International
0148-396X
1524-4040
Hagerstown
MD
[en] Adolescent ; Adult ; Aged ; Algorithms ; Cerebrospinal Fluid Rhinorrhea/etiology/surgery ; Child ; Craniocerebral Trauma/complications/surgery ; Dura Mater/pathology/surgery ; Female ; Fistula/etiology/pathology/surgery ; Humans ; Male ; Middle Aged ; Neurosurgical Procedures/methods ; Retrospective Studies ; Skull Base/pathology/surgery ; Skull Fractures/complications/pathology/surgery ; Tomography, X-Ray Computed
[en] OBJECTIVE: The management of cerebrospinal fluid (CSF) fistulae after anterior cranial base fracture remains a surgical challenge. We reviewed our results in the repair of CSF fistulae complicating multiple anterior cranial base fractures via a combined intracranial extradural and intradural approach and describe a treatment algorithm derived from this experience. METHODS: We retrospectively reviewed the files of 209 patients with an anterior cranial base fracture complicated by a CSF fistula who were admitted between 1980 and 2003 to Liege State University Hospital. Among those patients, 109 had a persistent CSF leak or radiological signs of an unhealed dural tear. All underwent the same surgical procedure, with combined extradural and intradural closure of the dural tear. RESULTS: Of the 109 patients, 98 patients (90%) were cured after the first operation. Persistent postoperative CSF rhinorrhea occurred in 11 patients (10%), necessitating an early complementary surgery via a transsphenoidal approach (7 patients) or a second-look intracranial approach (4 patients). No postoperative neurological deterioration attributable to increasing frontocerebral edema occurred. During the mean follow-up period of 36 months, recurrence of CSF fistula was observed in five patients and required an additional surgical repair procedure. CONCLUSION: The closure of CSF fistulae after an anterior cranial base fracture via a combined intracranial extradural and intradural approach, which allows the visualization and repair of the entire anterior base, is safe and effective. It is essentially indicated for patients with extensive bone defects in the cranial base, multiple fractures of the ethmoid bone and the posterior wall of the frontal sinus, cranial nerve involvement, associated lesions necessitating surgery such as intracranial hematomas, and post-traumatic intracranial infection. Rhinorrhea caused by a precisely located small tear may be treated with endoscopy.
http://hdl.handle.net/2268/57018
10.1227/01.neu.0000316014.97926.82

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