Aim: Skull base fractures represent 7–16% of head injuries and mainly affect the active and young population. The aim of this article is to report the epidemiological, clinical, anatomopathological, and therapeutic aspects of skull base fracture in adults treated in the neurosurgery department of our hospital.
Materials and methods: This was a retrospective, descriptive study of skull base fractures hospitalized from 1st January 2019 to 31st December 2021. The epidemiological, clinical, anatomopathological and therapeutic aspects of skull base fracture were analyzed.
Results: We collected 168 cases of skull base fracture. Young male adults were predominantly affected, with a mean age of 33.69 ± 13.70 years. The main cause was road traffic accidents (79.8%). The Glasgow score was 14 and 15 in 95.8% of cases. Around 17% of patients had cerebrospinal fluid (CSF) rhinorrhea and 7.7% had CSF otorrhea. All patients had undergone a brain scan. The fracture was located at the anterior skull base in 102 cases (60.7%) and at the temporal bone in 65 cases. Antibiotic prophylaxis was systematically prescribed for all patients. Pneumococcal vaccination was performed in 19.6% of patients. The posttraumatic hematoma was the main indication for surgical treatment. Duraplasty was indicated because of persistent rhinorrhea. There were two cases of bacterial meningitis among the CSF leaks. Two cases of death were recorded (1.2%), the cause of which was sepsis from bacterial meningitis and cerebral involvement following diffuse axonal injury.
Conclusion: The results of medical and surgical management of skull base fracture in our context were favorable. Prevention of infectious risks, including vaccination, should be mandatory.
Archer JB, Sun H, Bonney PA, et al. Extensive traumatic anterior skull base fractures with cerebrospinal fluid leak: classification and repair techniques using combined vascularized tissue flaps. J Neurosurg 2016;124(3):647–656. DOI: 10.3171/2015.4.JNS1528
Dreizin D, Sakai O, Champ K, et al. CT of skull base fractures: classification systems, complications, and management. Radiographics 2021;41(3):762–782. DOI: 10.1148/rg.2021200189
Schoentgen C, Henaux PL, Godey B, et al. Management of post-traumatic cerebrospinal fluid (CSF) leak of anterior skull base: 10 years experience. Acta Otolaryngol 2013;133(9):944–950. DOI: 10.3109/00016489.2013.793821
Yellinek S, Cohen A, Merkin V, et al. Clinical significance of skull base fracture in patients after traumatic brain injury. J Clin Neurosci 2016;25:111–115. DOI: 10.1016/j.jocn.2015.10.012
Bouchaouch A, Hassani FD, Abboud H, et al. Les traumatismes de l’étage antérieur de la base du crane: à propos d'une série de 136 cas. Pan Afr Med J 2015;21:155. DOI: 10.11604/pamj.2015.21.155.3511
Constanzo F, Pinto J, Sedaghat S, et al. Pseudo-cerebrospinal fluid leaks of the anterior skull base: algorithm for diagnosis and management. J Neurol Surg B Skull Base 2021;82(3):351–356. DOI: 10.1055/s-0039-3399519
Rajhi H, Salem A, Mhiri S, et al. Ce que le radiologue doit connaitre. Journal de Radiologie 2008;89(10):1507. DOI: 10.1016/S0221-0363(08)76626-5
Hedberg AL, Pauksens K, Enblad P, et al. Pneumococcal polysaccharide vaccination administered early after neurotrauma or neurosurgery. Vaccine 2017;35(6):909–915. DOI: 10.1016/j.vaccine.2016.12.065
Juliano AF, Ginat FD, Moonis G. Imaging review of the temporal bone: part II. Traumatic, postoperative, and noninflammatory nonneoplastic conditions. Radiology 2015;276(3):655–672. DOI: 10.1148/radiol.2015140800
Sivanandapanicker J, Nagar M, Kutty R, et al. Analysis and clinical importance of skull base fractures in adult patients with traumatic brain injury. J Neurosci Rural Pract 2018;09(3):370–375. DOI: 10.4103/jnrp.jnrp_38_18
Epaulard O, Brion JP. Phénicolés (chloramphénicol et thiamphénicol). EMC - Traité de médecine AKOS 2009;4(4):1–6. DOI: 10.1016/S1634-6939(09)45855-1
Biju RD, Wu J, Hussain Z. Tension pneumocephalus after skull base surgery. A case report and review of literature. J Clin Neurosci 2020;75:218–220. DOI: 10.1016/j.jocn.2020.03.041
Sweni S, Senthilkumaran S, Balamurugan N, et al. Tension pneumocephalus: a case report with review of literature. Emerg Radiol 2013;20(6):573–578. DOI: 10.1007/s10140-013-1135-7