Skull Base Fracture: Management in the Acute Phase

Abstract

Antibiotic prophylaxis, including the association of cephalosporins and phenicols for a period of 7 days with the single dose vaccine of Pneumococcal and Haemophilus influenzae type B. • These groups of patients were kept in a supine position with a CSF discharge test every 48 hours. Standing up was allowed after the cessation of discharge. • Surgical repair of osteomeningeal breaches is reserved for persistent CSF leaks beyond the 7th day of treatment. • The criteria of favorable evolution are the following-absence of CSF leaks from the 7th day of treatment, absence of meningitis and or meningoencephalitis, and total recovery of functional IntroductIonSkull base fractures represent 7-16% of head injuries. It mainly affects the active and young population. Skull base fractures are often ignored or even neglected in comatose patients. The diagnosis of skull base fracture is essential because of its serious complications, including meningitis in case of CSF leakage, vascular lesions, and cranial nerve palsies. 1 The main objective of this study is to report the epidemiological, clinical, anatomopathological, and therapeutic aspects of skull base fracture in adults in our center. MaterIals a n d MethodsThis was a retrospective descriptive study conducted in the Neurosurgery Department of the Joseph Ravoahangy Andrianavalona University Hospital (CHUJRA), Antananarivo, Madagascar, from 1 st January 2019 to 31 st December 2021. All patients aged 16 years and older, hospitalized for a skull base fracture operated or not, were included in this study.The following parameters were studied:• Epidemiological parameters-age, gender, etiology, location, and frequency of skull base fracture. • Clinical parameters-state of consciousness (Glasgow), rhinorrhea (yes/no), otorrhea (yes/no), periorbital ecchymosis (yes/no), epistaxis (yes/no), mastoid ecchymosis (yes/no), anosmia (yes/no), and signs of damage to the cranial nerves. • Paraclinical parameters-tomodensitometric characteristics of the lesions, biological examination (cytochemical and bacteriological examination of the CSF). • The evolutionary parameters-good evolution, complications, (infectious, functional, and vascular) and death.