Extensive traumatic anterior skull base fractures with cerebrospinal fluid leak: classification and repair techniques using combined vascularized tissue flaps

• DOI: 10.3171/2015.4.jns1528
• Publication Date: 2015-10-16T12:11:26Z
• Authors: Jacob B. Archer; Hai Sun; Phillip A. Bonney; Yan Daniel Zhao; Jared C. Hiebert; Jose A. Sanclement; Andrew S. Little; Michael E. Sughrue; Nicholas Theodore; Jeffrey James; Sam Safavi-Abbasi
• Keywords: Cribriform plate; Cerebrospinal fluid leak; Sinus (botany); Frontal sinus; Ethmoid sinus

This article introduces a classification scheme for extensive traumatic anterior skull base fracture to help stratify surgical treatment options. The authors describe their multilayer repair technique cerebrospinal fluid (CSF) leak resulting from using combination of laterally pediculated temporalis fascial-pericranial, nasoseptal-pericranial, and pericranial flaps.Retrospective chart review identified patients treated surgically between January 2004 May 2014 fractures with CSF fistulas. All were bifrontal craniotomy received pedicled tissue flaps. Cases classified according the extent fracture: Class I (frontal bone/sinus involvement only); II (extent ethmoid cribriform plate); III sphenoid bone/sinus). Surgical techniques tailored types fractures. Patients assessed at follow-up. Fisher exact test was applied investigate whether associated persistent postoperative leak.Forty-three in this series. Thirty-seven (86%) male. patients' mean age 33 years (range 11-79 years). overall length follow-up 14 months 5-45 months). Six as I, 8 II, 29 III. flap alone used (77%). Multiple flaps 10 (3 salvage) (28%)--1 9 Five (17%) 30 or who only single had (p < 0.31). No found multiple Although occurred high-grade repair, finding not significant.Extensive often require aggressive provide greatest long-term functional cosmetic benefits. Several vascularized can be used, either combination. Vascularized are an ideal substrate cranial repair. Dual triple that combine use various anterior, lateral, nasoseptal allow comprehensive arsenal multilayered salvage therapy severe