Severe craniofacial fractures with frontobasal involvement and cerebrospinal fluid fistula: indications for surgical repair.
BACKGROUND
The management of posttraumatic cerebrospinal fluid (CSF) fistulae is a controversial topic. Although recent literature shows that endoscopic repair of CSF fistula is efficacious and minimally invasive, in specific conditions open operative approach remains imperative.


METHODS
A series of 36 patients underwent surgery for posttraumatic CSF fistula according to specific selection criteria. These criteria included: bone displacement more than 1 cm (5 cases), location of fracture in proximity to the midline (6 cases), involvement of cribriform plate (12 cases), presence of encephalocele (3 cases), and failure of the conservative treatment (10 cases). The dural defect was closed using vascularized pericranium and fibrin glue. Closure of the basal bone defect was necessary in very large fractures or in special localization of the fistula, such as near the optic nerve. Mean clinical follow-up was 5.7 years.


RESULTS
Two patients presented meningitis without sequelae, and 12 with hyposmia. One patient died of the severity of the primary brain injury and associated extracranial lesions. None of the patients had recurrence.


CONCLUSIONS
Our results indicate that surgical dural repair in selected cases is related to low morbidity and mortality preserving from delayed risks such as recurrence and infections.
Rocchi
Giovanni
G
Department of Neurological Sciences, University of Rome La Sapienza, Rome, Italy.
Caroli
Emanuela
E
Belli
Evaristo
E
Salvati
Maurizio
M
Cimatti
Marco
M
Delfini
Roberto
R
D000293:Adolescent; D000328:Adult; D001929:Brain Edema / Q000473:pathology / Q000503:physiopathology; D002559:Cerebrospinal Fluid Rhinorrhea / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery*; D003663:Decision Trees; D005147:Facial Bones / Q000293:injuries / Q000473:pathology / Q000601:surgery; D005260:Female; D005402:Fistula / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery*; D005500:Follow-Up Studies; D005624:Frontal Bone / Q000293:injuries* / Q000473:pathology* / Q000601:surgery; D006801:Humans; D020198:Intracranial Hemorrhage, Traumatic / Q000473:pathology / Q000503:physiopathology; D008297:Male; D008581:Meningitis / Q000188:drug therapy / Q000209:etiology; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods / Q000706:statistics & numerical data; D018579:Patient Selection; D012886:Skull / Q000293:injuries / Q000473:pathology / Q000601:surgery; D020205:Skull Fracture, Basilar / Q000150:complications* / Q000503:physiopathology / Q000601:surgery*; D013530:Surgical Wound Infection / Q000188:drug therapy / Q000209:etiology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome