The Controversies in Skull Base Trauma

We have 21yy.(1992–2013) experiences and prospective study of skull base trauma. Our surgery group have more than 331 patients: the anterior skull base, middle, posterior open trauma.During anterior skull base reconstruction we protected the olfactory structures in 91%. Mortality v our series is 1,7%, morbidity posttraumatic 17%, postoperative 0,6%. Follow up in this series is 21 years.

Concurently with timing surgery study of open skull base fracture we have constituted group non-surgery treatment open skull base fracture. Our study group have together 116 cases, which come into being first 5 years (26,21,32,11,16). We have follow up of the group 20 years. We were all eyes on complications, which developing during 15–20years under different diagnosis: meningitis, meningoencephalis, abscessus cerebri, liquorhoea, pneumocephalus, Pott́s tumor, mucocoele, meninogencephalocoele, „polyps of paranasal sinuses“, „polyps of middle ear“, „cholesteatoma of middle ear“.

The criteria – our characteristics of choices to the non- surgery group:

• only intradural pneumopcephalus

• intradural pneumocephalus and liquorhoea, which stop during 24–48hours

• only liquorhoea, which stop during 24–48hours.

We have 4 non-surgery groups in time:

• meningitis, meningoencephalis, abscesu cerebri, liquorhoea, pneumocephalus

• meningitis, meningoencephalis, abscesu cerebri, liquorhoea, pneumocephalus, Pott́s tumor

• meningitis, meningoencephalis, abscesu cerebri, liquorhoea, pneumocephalus, Pott́s tumor, mucocele

• meningitis, meningoencephalis, abscesu cerebri, liquorhoea (more time so-called spontaneous), pneumocephalus, Pott́s tumor, mucocoele, meningocoele, meningoencephalocoele, „polyps of paranasal sinuses“, „polyps of middle ear“, „cholesteatoma of middle ear“.

The first group have maximum between half and 1 year after trauma after diagnosis (15,5%), the second group between 5–6 yy (12,1%), the third group between 11–13yy. (13,9%) and forth group 16–18yy. (9,4%).

We need to do exchanges conservetive treatment to surgery treatment in 58,6% during 21yy. under different diagnosis. If became the diagnosis after trauma late, the diagnosis have not immediate relation to traumatic diagnosis.

In lecture author will be discussed about new anatomical aspect of skull base, the biomechanical aspect of dura mater, the technical notes of different approaches of reconstruction, problems of timming of reconstruction or the contraversies between conservative and surgery treatment.

In our series we prefered acute operations and reconstructions of open skull base fracture with very effective goal. In reconstruction method we preffered vascularized flaps for reconstruction of dura. Author discussed problems of acute and delay reconstruction, discussed mortality and morbidity. Authors have experiences 21 years with acuta operations and reconstructions, diagnostic technics, treatment and follow up of patiens and correlate this surgery group with non-surgery group during 21yy..

Under this experiences in discusion prepade the kriteria for surgery or non-surgery treatment.

The skull base trauma is very important trauma with big consequence for health of patients.