Acute traumatic CSF fistulae: the risk of intracranial infection

Eljamel, Sam; Foy, P. M.

doi:10.3109/02688699008992759

Cited by 140 publications

(92 citation statements)

References 21 publications

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“…Only five reports comprised more than five patients. [7,13,15,16] In this respect, our study features a comparatively higher number of adult patients.…”

Section: Discussionmentioning

confidence: 97%

Evaluation of Posttraumatic Recürrent Bacterial Meningitis in Adults

Deveci

Uysal

Varol

et al. 2015

Ulus Travma Acil Cerrahi Derg

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“…Only five reports comprised more than five patients. [7,13,15,16] In this respect, our study features a comparatively higher number of adult patients.…”

Section: Discussionmentioning

confidence: 97%

Evaluation of Posttraumatic Recürrent Bacterial Meningitis in Adults

Deveci

Uysal

Varol

et al. 2015

Ulus Travma Acil Cerrahi Derg

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“…Other clinical findings are summarized in Table 2. The patients' neurological presentation varied widely; the mean Glasgow Coma Scale score was 9.8 (range [3][4][5][6][7][8][9][10][11][12][13][14][15].…”

Section: Results Patient Populationmentioning

confidence: 99%

“…The overall rate of infection ranges from 1.3% per day for the 1st week after a skull base fracture to 8.4% per year after the first 6 months. 15,20 Sakas and colleagues 49 reported a significantly higher infection rate in patients who had CSF rhinorrhea lasting longer than 8 days. In light of the high incidence of meningitis and mortality rates of 18.8% to 25%, 5,32 the rapid identification and treatment of CSF fistulas are critical to reducing long-term morbidity and mortality.…”

Section: Discussion Indications For Surgical Treatmentmentioning

confidence: 99%

“…However, recurrent CSF leakage after initial spontaneous cessation may occur and is associated with a 30% rate of recurrent meningitis and increased mortality. 15 Spontaneous resolution is also less likely in cases of extensive, comminuted anterior skull base fractures, especially those involving the ethmoid and sphenoid sinuses. In our series of 43 patients, several patients (7%) with chronic and persistent CSF leaks requiring subsequent conclusive reoperation and repair were referred to us after a delay to treatment.…”

Section: Discussion Indications For Surgical Treatmentmentioning

confidence: 99%

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Extensive traumatic anterior skull base fractures with cerebrospinal fluid leak: classification and repair techniques using combined vascularized tissue flaps

Archer¹,

Sun

Bonney³

et al. 2016

JNS

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OBJECT This article introduces a classification scheme for extensive traumatic anterior skull base fracture to help stratify surgical treatment options. The authors describe their multilayer repair technique for cerebrospinal fluid (CSF) leak resulting from extensive anterior skull base fracture using a combination of laterally pediculated temporalis fascial-pericranial, nasoseptal-pericranial, and anterior pericranial flaps. METHODS Retrospective chart review identified patients treated surgically between January 2004 and May 2014 for anterior skull base fractures with CSF fistulas. All patients were treated with bifrontal craniotomy and received pedicled tissue flaps. Cases were classified according to the extent of fracture: Class I (frontal bone/sinus involvement only); Class II (extent of involvement to ethmoid cribriform plate); and Class III (extent of involvement to sphenoid bone/sinus). Surgical repair techniques were tailored to the types of fractures. Patients were assessed for CSF leak at follow-up. The Fisher exact test was applied to investigate whether the repair techniques were associated with persistent postoperative CSF leak. RESULTS Forty-three patients were identified in this series. Thirty-seven (86%) were male. The patients’ mean age was 33 years (range 11–79 years). The mean overall length of follow-up was 14 months (range 5–45 months). Six fractures were classified as Class I, 8 as Class II, and 29 as Class III. The anterior pericranial flap alone was used in 33 patients (77%). Multiple flaps were used in 10 patients (3 salvage) (28%)—1 with Class II and 9 with Class III fractures. Five (17%) of the 30 patients with Class II or III fractures who received only a single anterior pericranial flap had persistent CSF leak (p < 0.31). No CSF leak was found in patients who received multiple flaps. Although postoperative CSF leak occurred only in high-grade fractures with single anterior flap repair, this finding was not significant. CONCLUSIONS Extensive anterior skull base fractures often require aggressive treatment to provide the greatest long-term functional and cosmetic benefits. Several vascularized tissue flaps can be used, either alone or in combination. Vascularized flaps are an ideal substrate for cranial base repair. Dual and triple flap techniques that combine the use of various anterior, lateral, and nasoseptal flaps allow for a comprehensive arsenal in multilayered skull base repair and salvage therapy for extensive and severe fractures.

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“…19 The antibiotic therapy was initiated on admission and stopped on the 3rd day after definitive closure of the defect.…”

Section: Operative Treatmentmentioning

confidence: 99%

Surgical treatment of complex traumatic frontobasal lesions: personal experience in 74 patients

Piek¹

2000

FOC

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Object The author's personal series included 148 patients who sustained traumatic frontobasal injuries and were treated between 1986 and 1999. Included in this study are 74 of 148 patients with acute injuries and complex fronto-basal lesions involving the frontal sinus, the cribriform/ethmoid roof complex, one or both orbital roofs, and the planum sphenoidale. Methods Surgery was delayed for up to 4 weeks postinjury in most patients (67 cases), whereas 17 with space-occupying hematomas and perforating injuries required early surgery. In 30 patients additional surgery was required to treat maxillofacial fractures, which was performed as a one-stage procedure together with the neurosurgical operation. The author performed a standard bifrontal craniotomy in which an intradural or combined intradural–extradural approach was used in all cases. Four patients developed ascending meningitis in the preoperative period. As a result of surgical treatment one patient died, another two patients suffered from permanent defects, and three suffered from transitory neurological worsening. In two patients recurrence of a cerebrospinal fluid fistula occurred within a 3-month period posttreatment but was successfully obliterated during reoperation. In the author's experience the intradural approach is comparable in terms of the morbidity, mortality, and success rates with extracranial approaches; additionally the intradural approach provides full visualization of the intracranial lesion. Useful olfactory nerve function can only be preserved if both olfactory nerves are left intact and not crushed during initial injury; this occurred in only five patients in this series. Conclusions If possible, surgical treatment of more complex lesions should be delayed until the 2nd or 3rd week following traumatic injury. With antibiotic prophylaxis the risk that ascending meningitis will occur prior to surgery is low. If the patient is systemically stable and brain swelling has resolved, even extensive one-stage neurosurgical/ maxillofacial procedures are well tolerated.

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Acute traumatic CSF fistulae: the risk of intracranial infection

Cited by 140 publications

References 21 publications

Evaluation of Posttraumatic Recürrent Bacterial Meningitis in Adults

Evaluation of Posttraumatic Recürrent Bacterial Meningitis in Adults

Extensive traumatic anterior skull base fractures with cerebrospinal fluid leak: classification and repair techniques using combined vascularized tissue flaps

Surgical treatment of complex traumatic frontobasal lesions: personal experience in 74 patients

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