Osteo-Meningeal Breaches in Benin

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“…Glucose concentrations greater than 0.3 g/L and protein concentrations up to 2 g/L are considered indicative of CSF [6]. But, the necessity of large samples, the contamination in the event of blood and the rate of false positive up to 45-75% are important disadvantages [6,7]. However, even if the determination by glucose test strips in bedside secretions has low sensitivity and specificity, it can be useful in the emergency room [7].…”

“…The therapeutic management of OMB must consider the cause, the anatomic site, the size of the defect, the age of the patient and the underlying intracranial pressure [7]. In the secondary forms of OMB, the treatment of the etiology is mandatory while the breach closing alone is enough for primary OMB [1].…”

“…The extracranial approach, trans-ethmoidal, trans-septal or endoscopic endonasal, is indicated for the limited OMB of the anterior floor of the skull base with no associated cerebral lesion [2]. The endonasal endoscopic approach is the classical and most currently practiced because of the aesthetic benefit and conclusive results [7]. They allow the closing of OMB of the criblate plate or the roof of the ethmoid and sphenoid using grafts collected on site (nasal septum) or afar (abdominal fat, tragal cartilage, fascia lata) [2].…”

“…The second surgical part consists of clogging the breach by an interposition technic with septal or turbinal mucosa graft, retroauricular or abdominal fat, fascia temporalis or fascia lata of the thigh or neuropatch [2]. As grafting material, the use of bone or cartilage is not required unless herniation of the meninges or brain is present [5] If unsuccessful, with persistent spontaneous fistulas, or large bone crash, or in the presence of a concomitant high-pressure hydrocephalus, a ventriculo-peritoneal or ventricular-atrial shunt is produced [7]. The two life-threatening postoperative complications are mainly represented by intracranial hypertension and meningitis which is prevented by IV injection of third generation of cephalosporin [7].…”