One-stage reconstruction surgery for pediatric comminuted and depressed fractures of frontal bone and anterior skull base

Abstract

Objective To explore the surgical techniques and effects of one-stage reconstruction surgery for pediatric comminuted and depressed fractures of frontal bone and anterior skull base. Methods The clinical data of 13 pediatric cases with one-stage reconstruction surgery for comminuted and depressed fractures of the frontal bone and anterior skull base were reviewed retrospectively, including 8 male and 5 female, aged from 4 to 14 years, with a mean age of 8 years.Admission Glasgow Coma Scale (GCS) was as follows: 3 to 8 scores in 2 cases, 9 to 11 scores in 4 cases, and 12 to 15 scores in 7 cases.The intraoperative one- stage osseous and vascular pedicle membranous reconstruction of frontal bone and anterior skull base had been performed in all patients.The periosteum-bone fragments-periosteum had been used in 4 cases whose bony defect diameter of anterior cranial fossa was over 1 cm, multimodality therapy were carried out postoperatively.The follow-ups were regularly executed after discharge. Results GCS at discharge was as follows: 3 to 8 scores in 1 case, 9 to 11 scores in 2 cases, and 12 to 15 scores in 10 cases.No significant difference was found in GCS between those on admission and at discharge(χ2=3.02, P>0.05). Eleven cases had a phenomenon of nasal hemorrhage and the duration was not exceeding 48 hours.No intracranial infection and cerebrospinal fluid leakage occurred in all patients.All patients received an acceptable appearance without obvious frontal depre-ssion or proptosis.Postoperative computed tomography image showed normal cranial volume, well reset of fracture pieces, no fracture pieces existing in intracerebral tissue, satisfactory hematoma evacuation, and orbital contents without compression.The complications like cerebrospinal fluid leakage, poor incision healing, brain abscess or mucous cyst had not been found in all patients from 3 months to 6 years follow-up period. Conclusions The one-stage reconstruction surgery for pediatric comminuted and depressed fractures of frontal bone and anterior skull base suggests a better prognosis, effectively less complications, which helps to avoid secondary surgery, but regular follow-ups are absolutely necessary.This procedure is worth applying and spreading to pediatric patients and medical institutions if necessary. Key words: One-stage reconstruction; Comminuted and depressed fracture; Frontal bone; Anterior skull base; Child