Different methods for the reconstruction of the skull base of open craniocerebral injury combined with comminuted factures of the base of anterior cranial fossa

Abstract

Objective To investigate the efficacy of different methods for reconstruction of the skull base of open craniocerebral injury combined with the base of anterior cranial fossa fracture. Methods The data of 46 patients with skull base reconstruction admitted from October 2009 to October 2014 were studied retrospectively. They were divided into either an observation group(n=21)or a control group(n=25)according to the ways of skull base reconstruction. The observation group was repaired withsandwichtherapy; while the control group only used artificial dura or direct suture of tendon membrane for reconstruction. The complications such as postoperative cerebrospinal fluid leakage, intracranial infection, meningoencephalocele, and reject reaction of both groups were observed. Results The patients were followed up for 3 to 36 months(mean 15.8). Of the 21 patients in the observation group, only 1 occurred cerebrospinal fluid leakage. They were cured after treatment. No complications, such as intracranial infection and meningoencephalocele were observed. The incidence of complications was 4.8%(1/21). Of the 25 patient in the control group, 8 occurred cerebrospinal fluid leakage, including 5 cases complicated with intracranial infection. They were cured after treatment. Two patients had meningoencephalocele. The incidence of complications was 40.0%(10/25). There was significant difference in the incidence of complications between the 2 groups(P<0.05). Conclusion In the emergency operation for open craniocerebral injury combined with the factures of base of anterior cranial fossa, performingsandwichtherapy for skull base reconstruction may effectively control the complications, such as intracranial infection and cerebrospinal fluid leakage, and improve the prognosis of patients. Key words: Skull base; Bone remodeling; Skull fractures; Cranial fossa, anterior; Central nervous system bacterial infections; Cerebrospinal fluid leakage