Multidisciplinary surgical approach for cerebrospinal fluid leak in children with complex head trauma.
BACKGROUND
Post-traumatic cerebrospinal fluid leak from the anterior cranial fossa in children may be isolated or combined with severe facial and calvarial injury. Untreated leak may result with meningitis, hydrocephalus, and abnormal neurocognitive development.


METHODS
We present nine children, ages 4-16 years, with complicated craniofacial injury treated by a combined subcranial and intracranial approach. A continuous lumbar drainage was kept for several days, and prophylactic antibiotics and anti-convulsive medications were routinely given. A multidisciplinary approach including discussion before surgery about other surgical options (endoscopic extracranial and intracranial alone) were performed.


RESULTS
None of the operated children had episodes of meningitis/leak after the combined approach, suggesting that appropriate sealing of the base of the skull has been achieved. There was no mortality, and the long-term follow-up showed good developmental and cosmetic results. Most of the children had significant brain contusions prior to surgery; however, these did not progress as minimal retraction was enabled by the extensive subcranial and intracranial approach.


CONCLUSIONS
Child's age, anatomy of the bone, extent of cranial injury, and clinical parameters should be seriously considered when choosing the technical methods as for sealing base of skull and reconstruction of facial/cranial bones. Young age does not seem to be a contraindication to the combined approach, thus, we recommend considering it in extensive base of skull fractures when concomitant cranial, maxillofacial, and orbital fractures coexist, as alternative options may not suffice in these cases.
Fishman
Gadi
G
Department of Otolaryngology Head and Neck Surgery, Tel-Aviv Sourasky Medical Center and Dana Children's Hospital, Tel-Aviv University, Tel-Aviv, Israel.
Fliss
Dan M
DM
Benjamin
Shlomi
S
Margalit
Nevo
N
Gil
Ziv
Z
Derowe
Ari
A
Constantini
Shlomi
S
Beni-Adani
Liana
L
D000367:Age Factors; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000927:Anticonvulsants / Q000627:therapeutic use; D002555:Cerebrospinal Fluid; D002558:Cerebrospinal Fluid Otorrhea / Q000209:etiology / Q000601:surgery*; D002559:Cerebrospinal Fluid Rhinorrhea / Q000209:etiology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D035262:Cranial Fossa, Anterior / Q000000981:diagnostic imaging / Q000601:surgery; D006259:Craniocerebral Trauma / Q000150:complications* / Q000188:drug therapy / Q000601:surgery*; D003399:Craniotomy / Q000379:methods; D004322:Drainage / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D019651:Plastic Surgery Procedures / Q000379:methods; D012886:Skull / Q000000981:diagnostic imaging / Q000601:surgery; D013524:Surgical Flaps; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D000927:Anticonvulsants