Controversies in the Management of Open Fractures of the Skull Base

Abstract

Skull base trauma is a very important trauma with big consequences in patients' health. Our group has 240 patients who underwent reconstruction surgery in the following skull base trauma locations: anterior (162), middle (70), and posterior (6). In addition, 2 patients had post-traumatic exchange volumes of orbital space. During anterior skull base reconstruction, we protected the olfactory structures in 91%. Mortality in our series was 1.7%, post-traumatic morbidity 17%, and postoperative morbidity 0.6%. Follow-up in this series was 17 years. We studied different post-traumatic pathological problems on olfactory structures, i.e., destruction or contusion or hematoma into the olfactory bulb, destruction of the olfactory tract, and destruction or contusions in the olfactory trigonum. In our series, we preferred acute operations and reconstructions of open skull base fractures with achievable goals. The method we preferred for reconstruction involved vascularized flaps for reconstruction of dura. We will discuss problems of acute and delay reconstructions, as well as mortality and morbidity. We have 17 years of experience with acute operations and reconstructions, diagnostic techniques, treatment, and follow-up of patients.