[The neurosurgical treatment of traumatic fronto-basal spinal fluid fistulas. 66 cases (1982-1986)]

Abstract

Between 1982 and 1986, 66 patients suffering from traumatic frontobasal CSF fistulas were treated neurosurgically i.e. via a transcranial approach. In 68% an additional transcranial space-occupying lesion a direct open endocranium and/or a large basal cerebral hernia were found. The cases and relevant findings are discussed, followed by deliberations on the points enumerated below: --diagnostic, especially neuroradiological advances --problems of indications for surgery --the problem of the best possible surgical approach Both cranial and rhinological approach have their pros and cons. Their indications agree only partly, so that the choice of the method depends especially on the individual pathology. Progress has been achieved in recent years both neurosurgically and rhinologically. Neurosurgical results have been improved upon, and postoperative complications after cranial approach are now rare. Essential factors, apart from selecting the best possible time for surgery, are: --adequate intracranial debridement --the use of a microsurgical technique, as well as application of a various brain-protective, measures as stated in this article. Further progress is fundamentally based on best possible mutual cooperation between the disciplines involved, paying increased attention in future to endocrinological problems.