Craniofacial trauma and cerebrospinal fluid leakage: a retrospective clinical study.
OBJECTIVE
The study examines the efficacy of antibiotic treatment in patients with traumatic cerebrospinal fluid (CSF) leakage and identifies a consistent clinical approach for better management of these patients.


METHODS
A retrospective study of traumatic CSF leakage in 88 patients with craniofacial fractures was performed. The mechanism of injury, etiology and source of leakage, decision to treat conservatively (without surgery) versus aggressively (with surgery), decision to use early versus late repair, and decision to provide prophylactic antibiotic coverage were recorded. Both timing of repair and the decision to use antibiotics were compared with the incidence of meningitis resulting from CSF leakage.


RESULTS
Of 48 patients treated with antibiotics, 5(10.4%) developed meningitis. In the remaining 40 who were not treated with antibiotics, only one patient acquired meningitis. Five of 53 (9.4%) patients with conservative treatment developed meningitis versus 1 of 35 (2.9%) after aggressive treatment.


CONCLUSIONS
There was no statistically significant difference in the rate of occurrence of meningitis between the conservative and the aggressive treatment group. However, the data suggest that there may be no benefit in treating these patients with antibiotics to prevent meningitis, whereas aggressive treatment and early repair of facial fractures may, in fact, be helpful.
Clemenza
J W
JW
Department of Surgery, Allegheny General Hospital, Pittsburgh, PA, USA.
Kaltman
S I
SI
Diamond
D L
DL
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002558:Cerebrospinal Fluid Otorrhea / Q000150:complications / Q000209:etiology* / Q000628:therapy; D002559:Cerebrospinal Fluid Rhinorrhea / Q000150:complications / Q000209:etiology* / Q000628:therapy; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D008581:Meningitis / Q000209:etiology / Q000517:prevention & control; D008875:Middle Aged; D011292:Premedication; D012189:Retrospective Studies; D012887:Skull Fractures / Q000150:complications* / Q000601:surgery; D013997:Time Factors
D000900:Anti-Bacterial Agents