TY - JOUR
T1 - A management algorithm for cerebrospinal fluid leak associated with anterior skull base fractures
T2 - Detailed clinical and radiological follow-up
AU - Sherif, Camillo
AU - Di Ieva, Antonio
AU - Gibson, Daniel
AU - Bita, Pakrah Bodingbauer
AU - Widhalm, Georg
AU - Irena, Krusche Mandl
AU - Erdoes, Jozsef
AU - Gilloon, Benjamin
AU - Matula, Christian
PY - 2012/4
Y1 - 2012/4
N2 - Detailed outcome data for the management of anterior skull base fractures associated with cerebrospinal fluid (CSF) leakage is lacking. We present detailed follow-up data of a single-center study using a predetermined algorithm for the management of CSF leakage secondary to traumatic fractures. A number of 138 consecutive patients were included in the analysis; all patients underwent high-resolution computed tomography (CT) scanning at time of admission with β2- transferrin testing used to confirm CSF leakage. Patients with acute surgical indications were operated as emergent; leaks were repaired at the time of initial surgery in patients with intracranial pressure<15 cm H2O. The remainder of the study population was managed conservatively including use of prophylactic antibiotics; lumbar drainage (LD) catheters were placed in those patients with leakage persisting beyond 48 h. Leaks lasting longer than 5 days underwent microsurgical repair using an intradural bicoronal approach. One-year follow-up assessment included evaluation of neurological status, Glasgow Outcome Scale (GOS), and repeat head CT. Twenty eight patients (26.9%) underwent emergent surgery, 15 of whom had simultaneous CSF leak repair, whereas 76 patients (73.1%) underwent delayed CSF leak repair between days 5 and 14. Postoperative meningitis rate was low (1.9%). Postoperative CSF leak (1.9%) was managed by intradural or transnasal endoscopic operation. Comparable rates of anosmia and frontal lobe hypodensities were seen in the surgical and conservatively managed subgroups. The presented algorithm, utilizing prophylactic antibiotics, trial of LD, acute and/or delayed intradural microsurgery, yields favorable outcomes. Large randomized controlled trials are needed to better define the role of prophylactic antibiotics and to better characterize the optimal timing and approach of surgical repair.
AB - Detailed outcome data for the management of anterior skull base fractures associated with cerebrospinal fluid (CSF) leakage is lacking. We present detailed follow-up data of a single-center study using a predetermined algorithm for the management of CSF leakage secondary to traumatic fractures. A number of 138 consecutive patients were included in the analysis; all patients underwent high-resolution computed tomography (CT) scanning at time of admission with β2- transferrin testing used to confirm CSF leakage. Patients with acute surgical indications were operated as emergent; leaks were repaired at the time of initial surgery in patients with intracranial pressure<15 cm H2O. The remainder of the study population was managed conservatively including use of prophylactic antibiotics; lumbar drainage (LD) catheters were placed in those patients with leakage persisting beyond 48 h. Leaks lasting longer than 5 days underwent microsurgical repair using an intradural bicoronal approach. One-year follow-up assessment included evaluation of neurological status, Glasgow Outcome Scale (GOS), and repeat head CT. Twenty eight patients (26.9%) underwent emergent surgery, 15 of whom had simultaneous CSF leak repair, whereas 76 patients (73.1%) underwent delayed CSF leak repair between days 5 and 14. Postoperative meningitis rate was low (1.9%). Postoperative CSF leak (1.9%) was managed by intradural or transnasal endoscopic operation. Comparable rates of anosmia and frontal lobe hypodensities were seen in the surgical and conservatively managed subgroups. The presented algorithm, utilizing prophylactic antibiotics, trial of LD, acute and/or delayed intradural microsurgery, yields favorable outcomes. Large randomized controlled trials are needed to better define the role of prophylactic antibiotics and to better characterize the optimal timing and approach of surgical repair.
KW - Anterior skull base fractures
KW - Cerebrospinal fluid (CSF) leak
KW - Intradural bicoronal approach
KW - Microsurgery
KW - Traumatic brain injury
UR - http://www.scopus.com/inward/record.url?scp=84862841197&partnerID=8YFLogxK
U2 - 10.1007/s10143-011-0352-3
DO - 10.1007/s10143-011-0352-3
M3 - Review article
VL - 35
SP - 227
EP - 237
JO - Neurosurgical Review
JF - Neurosurgical Review
SN - 0344-5607
IS - 2
ER -