J Neurol Surg B Skull Base 2017; 78(S 01): S1-S156
DOI: 10.1055/s-0037-1600737
Poster Abstracts
Georg Thieme Verlag KG Stuttgart · New York

Prospective Study 24YY. Conservative Treatment of Skull Base Trauma

Jan Hemza
1   Department of Neurosurgery, Faculty Hospital at Saint Ann
› Author Affiliations
Further Information

Publication History

Publication Date:
02 March 2017 (online)

 

We have 24yy. (1992–2016) experiences with open skull base fracture and prospective study of skull base trauma.

Our surgery group has more than 346 patients: the anterior skull base, middle, posterior open trauma. During anterior skull base reconstruction, we protected the olfactory structures in 91%. Mortality rate in our series is 1.7%, posttraumatic morbidity is 17%, and postoperative is 0.6%. Follow-up in this series is 24 years.

Concurrently with timing of surgery for the study of open skull base fracture, we have constituted groups into nonsurgery treatment and open skull base fracture. Our study groups have altogether 116 cases, which come into being in the first 5 years. We have follow-up of 24 years. We were all eyes on complications, which develop during 15 to 20 years under different diagnosis: meningitis, meningoencephalitis, abscessus cerebri, liquorrhea, pneumocephalus, Pott´s tumor, mucocele, meningoencephalocele, “polyps of paranasal sinuses,” “polyps of middle ear,” “cholesteatoma of middle ear.”

Criteria—our characteristics of choices to the nonsurgery group: only intradural pneumocephalus, intradural pneumocephalus, and liquorrhea stop during 24 to 48 hours; only liquorrhea stops during 24 to 48 hours.

Surgery group studies ICP trend during 14 days. This group included 113 patients.

  1. We have four nonsurgery groups in time: Meningitis, meningoencephalocele, abscess cerebri, liquorrhea, pneumocephalus

  2. Meningitis, meningoencephalocele, abscess cerebri, liquorrhea, pneumocephalus, Pott´s tumor

  3. Meningitis, meningoencephalocele, abscess cerebri, liquorrhea, pneumocephalus, Pott´s tumor, mucocele

  4. Meningitis, meningoencephalocele, abscess cerebri, liquorrhea (more time so-called spontaneous), pneumocephalus, Pott´s tumor, mucocele, meningocele, meningoencephalocele, “polyps of paranasal sinuses,” “polyps of middle ear,” “cholesteatoma of middle ear.”

The first group has maximum between half and 1 year after trauma after diagnosis (15,5%), the second group between 5 and 6 yy (12.1%), the third group between 11 and 13 yy. (13.9%), and forth group between 16 and 18 yy. (9.4%).

We need to do exchanging of conservative treatment to surgery treatment in 58.6% during 24 yy. under different diagnosis. If the diagnosis after trauma is late, the diagnosis has not immediate relation to traumatic diagnosis. ICP trend is partial answer on problems of exchanging conservative treatment to surgery.

In the lecture, the author will be discussed personal experiences about two different groups of open skull base fracture surgery and nonsurgery group with follow-up of 24 years.

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