title: Surgical management of anterior cranial base fractures with cerebrospinal fluid fistulae: a single-institution experience.
abstract: OBJECTIVE
  The management of cerebrospinal fluid (CSF) fistulae after anterior cranial base fracture remains a surgical challenge. We reviewed our results in the repair of CSF fistulae complicating multiple anterior cranial base fractures via a combined intracranial extradural and intradural approach and describe a treatment algorithm derived from this experience.
  
  
  METHODS
  We retrospectively reviewed the files of 209 patients with an anterior cranial base fracture complicated by a CSF fistula who were admitted between 1980 and 2003 to Liège State University Hospital. Among those patients, 109 had a persistent CSF leak or radiological signs of an unhealed dural tear. All underwent the same surgical procedure, with combined extradural and intradural closure of the dural tear.
  
  
  RESULTS
  Of the 109 patients, 98 patients (90%) were cured after the first operation. Persistent postoperative CSF rhinorrhea occurred in 11 patients (10%), necessitating an early complementary surgery via a transsphenoidal approach (7 patients) or a second-look intracranial approach (4 patients). No postoperative neurological deterioration attributable to increasing frontocerebral edema occurred. During the mean follow-up period of 36 months, recurrence of CSF fistula was observed in five patients and required an additional surgical repair procedure.
  
  
  CONCLUSIONS
  The closure of CSF fistulae after an anterior cranial base fracture via a combined intracranial extradural and intradural approach, which allows the visualization and repair of the entire anterior base, is safe and effective. It is essentially indicated for patients with extensive bone defects in the cranial base, multiple fractures of the ethmoid bone and the posterior wall of the frontal sinus, cranial nerve involvement, associated lesions necessitating surgery such as intracranial hematomas, and post-traumatic intracranial infection. Rhinorrhea caused by a precisely located small tear may be treated with endoscopy.
authors.affiliation: Department of Neurosurgery, Liège University Hospital, Liège State University, Liège, Belgium.
authors.forename: Martin
authors.initials: M
authors.lastname: Scholsem
authors.forename: Felix
authors.initials: F
authors.lastname: Scholtes
authors.forename: Frèderick
authors.initials: F
authors.lastname: Collignon
authors.forename: Pierre
authors.initials: P
authors.lastname: Robe
authors.forename: Annie
authors.initials: A
authors.lastname: Dubuisson
authors.forename: Bruno
authors.initials: B
authors.lastname: Kaschten
authors.forename: Jacques
authors.initials: J
authors.lastname: Lenelle
authors.forename: Didier
authors.initials: D
authors.lastname: Martin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D002559:Cerebrospinal Fluid Rhinorrhea / Q000209:etiology / Q000601:surgery; D002648:Child; D006259:Craniocerebral Trauma / Q000150:complications / Q000601:surgery; D004388:Dura Mater / Q000473:pathology / Q000601:surgery; D005260:Female; D005402:Fistula / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D012189:Retrospective Studies; D019291:Skull Base / Q000473:pathology / Q000601:surgery*; D012887:Skull Fractures / Q000150:complications / Q000473:pathology / Q000601:surgery*; D014057:Tomography, X-Ray Computed