The subcranial approach to trauma of the anterior cranial base: preliminary report.
The subcranial approach to the cranio-orbito-frontal junction allows direct access to the central anterior cranial base for repair of fractures, dural tears, and cerebrospinal fluid fistulae. It provides good visualization without brain retraction and is suitable in primary or delayed traumatic cases. For extended visualization, a portion of the frontal sinus may be removed and repositioned at the end of the procedure. Because the brain is not retracted, morbidity is low. Potential and active cerebrospinal fluid fistulae can be successfully managed with the use of free fascial grafts and often do not require a pericranial flap. Contraindications include parenchymal brain injury or bleeding that may require a more standard frontal craniotomy for management. The purpose of this report is to highlight the use of the subcranial approach to repair cerebrospinal fluid fistulae in immediate and delayed traumatic cases.
Gliklich
R E
RE
Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA.
Lazor
J B
JB
D000293:Adolescent; D000328:Adult; D001930:Brain Injuries / Q000150:complications; D002559:Cerebrospinal Fluid Rhinorrhea / Q000601:surgery; D000075202:Contraindications; D003399:Craniotomy; D004388:Dura Mater / Q000293:injuries / Q000601:surgery; D005004:Ethmoid Bone / Q000293:injuries; D005205:Fascia / Q000637:transplantation; D005624:Frontal Bone / Q000601:surgery; D005626:Frontal Sinus / Q000293:injuries / Q000601:surgery; D006801:Humans; D020300:Intracranial Hemorrhages / Q000150:complications; D008297:Male; D008586:Meningitis, Pneumococcal / Q000601:surgery; D009295:Nasal Bone / Q000293:injuries; D009915:Orbit / Q000601:surgery; D009917:Orbital Fractures / Q000601:surgery; D011183:Postoperative Complications / Q000601:surgery; D019291:Skull Base / Q000293:injuries*; D012887:Skull Fractures / Q000601:surgery*