TY - JOUR
T1 - Multidisciplinary surgical approach for cerebrospinal fluid leak in children with complex head trauma
AU - Fishman, Gadi
AU - Fliss, Dan M.
AU - Benjamin, Shlomi
AU - Margalit, Nevo
AU - Gil, Ziv
AU - Derowe, Ari
AU - Constantini, Shlomi
AU - Beni-Adani, Liana
PY - 2009/8
Y1 - 2009/8
N2 - Introduction: Post-traumatic cerebrospinal fluid leak from the anterior cranial fossa in children may be isolated or combined with severe facial and calvarial injury. Untreated leak may result with meningitis, hydrocephalus, and abnormal neurocognitive development. Patients and methods: We present nine children, ages 4-16 years, with complicated craniofacial injury treated by a combined subcranial and intracranial approach. A continuous lumbar drainage was kept for several days, and prophylactic antibiotics and anti-convulsive medications were routinely given. A multidisciplinary approach including discussion before surgery about other surgical options (endoscopic extracranial and intracranial alone) were performed. Results: None of the operated children had episodes of meningitis/leak after the combined approach, suggesting that appropriate sealing of the base of the skull has been achieved. There was no mortality, and the long-term follow-up showed good developmental and cosmetic results. Most of the children had significant brain contusions prior to surgery; however, these did not progress as minimal retraction was enabled by the extensive subcranial and intracranial approach. Conclusions: Child's age, anatomy of the bone, extent of cranial injury, and clinical parameters should be seriously considered when choosing the technical methods as for sealing base of skull and reconstruction of facial/cranial bones. Young age does not seem to be a contraindication to the combined approach, thus, we recommend considering it in extensive base of skull fractures when concomitant cranial, maxillofacial, and orbital fractures coexist, as alternative options may not suffice in these cases.
AB - Introduction: Post-traumatic cerebrospinal fluid leak from the anterior cranial fossa in children may be isolated or combined with severe facial and calvarial injury. Untreated leak may result with meningitis, hydrocephalus, and abnormal neurocognitive development. Patients and methods: We present nine children, ages 4-16 years, with complicated craniofacial injury treated by a combined subcranial and intracranial approach. A continuous lumbar drainage was kept for several days, and prophylactic antibiotics and anti-convulsive medications were routinely given. A multidisciplinary approach including discussion before surgery about other surgical options (endoscopic extracranial and intracranial alone) were performed. Results: None of the operated children had episodes of meningitis/leak after the combined approach, suggesting that appropriate sealing of the base of the skull has been achieved. There was no mortality, and the long-term follow-up showed good developmental and cosmetic results. Most of the children had significant brain contusions prior to surgery; however, these did not progress as minimal retraction was enabled by the extensive subcranial and intracranial approach. Conclusions: Child's age, anatomy of the bone, extent of cranial injury, and clinical parameters should be seriously considered when choosing the technical methods as for sealing base of skull and reconstruction of facial/cranial bones. Young age does not seem to be a contraindication to the combined approach, thus, we recommend considering it in extensive base of skull fractures when concomitant cranial, maxillofacial, and orbital fractures coexist, as alternative options may not suffice in these cases.
KW - Base of skull
KW - CSF leak
KW - Combined extracranial-intracranial approach
KW - Craniofacial trauma
KW - Craniotomy
KW - Fractures
KW - Pediatric head trauma
KW - Reconstruction
UR - http://www.scopus.com/inward/record.url?scp=67749101763&partnerID=8YFLogxK
U2 - 10.1007/s00381-009-0887-6
DO - 10.1007/s00381-009-0887-6
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C2 - 19415300
AN - SCOPUS:67749101763
SN - 0256-7040
VL - 25
SP - 915
EP - 923
JO - Child's Nervous System
JF - Child's Nervous System
IS - 8
ER -