[Neurosurgical aspects of frontobasal injuries with cerebrospinal fluid fistulas: experience with 205 operated patients]

Abstract

Over a period of 15 years the author operated on 205 patients with traumatic frontobasal CSF fistulas. In one third of these cases, exploration had to take place within 24 hours because of cerebral compression or a direct open injury. Craniotomy enables the surgeon to repair the concomitant neurosurgical lesions frequently found (57%) as well as the often multiple (56%) or bilateral (35.3%) fistulas. As regards surgical technique, the important points are: protection of the brain thanks to the use of magnification, the best possible approach, lumbar puncture during surgery to relieve pressure, sufficient cerebral debridement and in the paranasal sinuses, reliable closure of the fistula (duraplasty and sometimes additional plastic closure of the bony defect), and consideration of the latest findings of neuroanaesthesia, endocrinology etc. Nearly two-thirds of the patients operated were able to resume work completely.