The Controversies in Open Skull Base Trauma

We have 22 years (1192–2014) experiences with open skull base fracture and prospective study of skull base trauma.

Our surgery group has more than 330 patients: the anterior skull base, middle, and posterior open trauma. During anterior skull base reconstruction we protected the olfactory structures in 91%. Mortality versus our series is 1.7%, morbidity posttraumatic 17%, postoperative 0.6%. Follow-up in this series is 22 years.

Concurrently with timing surgery study of open skull base fracture we have constituted group nonsurgery treatment open skull base fracture. Our study group have together 116 cases, which come into being first 5 years (26,21,32,11, and 16). We have follow-up of the group 20 years. We were all eyes on complications, which developing during 15 to 20years under different diagnosis: meningitis, meningoencephalis, abscesses cerebri, liquorrhea, pneumocephalus, Pott tumor, mucocele, meningoencephalocele, “polyps of paranasal sinuses,”, “polyps of middle ear,” and “cholesteatoma of middle ear”.

The criteria of our characteristics of choices to the nonsurgery group: only intradural pneumocephalus intradural pneumocephalus and liquorrhea, which stop during 24 to 48 hours and only liquorrhea, which stop during 24 to 48 hours. We have four nonsurgery groups in time: meningitis, meningoencephalis, abscesu cerebri, liquorrhea, pneumocephalusmucocoelemeningitis, meningoencephalis, abscesu cerebri, liquorrhea (more time so-called spontaneous), pneumocephalus, Pott tumor, mucocele, meningocele, meningoencephalocele, “polyps of paranasal sinuses,” “polyps of middle ear,” “cholesteatoma of middle ear”.

The first group have maximum between 0.5 and 1 year after trauma after diagnosis (15.5%), the second group between 5 to 6 years (12.1%), the third group between 11 and 13 years (13.9%), and the forth group 16 to 18 year (9.4%).

We need to do exchanges conservative treatment to surgery treatment in 58.6% during 20 years under different diagnosis. If the diagnosis after trauma is late, the diagnosis has no immediate relation to traumatic diagnosis.

In lecture, author will be discussed personal experiences about two different group of open skull base fracture—surgery and nonsurgery group with follow-up of 22 years.

Author discussed problems of acute and delay reconstruction, discussed mortality and morbidity. Authors have experiences 2 years with acuta operations and reconstructions, diagnostic technics, research of biomechanical and biophysical characteristic of dura, new anatomy of any part skull base, treatment and follow-up of patients and correlate this surgery group with nonsurgery group during 22 years.

Under this experience, there is prepare the criteria for surgery or nonsurgery treatment.

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