Research Reports - Clinical significance of skull base fracture in patients after traumatic brain injury

J Clin Neurosci. 2015 Dec 24. pii: S0967-5868(15)00536-6. doi:
10.1016/j.jocn.2015.10.012. [Epub ahead of print]

Yellinek S(1), Cohen A(1), Merkin V(1), Shelef I(2), Benifla M(3).

About 4% of all head injuries include skull base fractures. Most of these
fractures (90%) are secondary to closed head trauma; the remainder are due to
penetrating trauma. We reviewed the records from January 2006 through December
2008 of all patients older than 18years of age who arrived at Soroka Medical
Center in Be'er-Sheva, Israel, with skull base fractures following a traumatic
brain injury (TBI). We identified 107 patients with a mean age of 42years at the
time of TBI. Glasgow Coma score on arrival predicted the clinical outcome. We
observed temporal fractures in 30% of these patients, occipital fractures in 20%,
pyramidal fractures in 19%, anterior skull base fractures in 17%, and multiple
fractures in 14%. Cerebrospinal fluid (CSF) leak was observed in 16 patients
(15%). Of the patients experiencing CSF leaks, otorrhea occurred in 10 (62%) and
rhinorrhea occurred in six (37%). Three patients required surgical intervention
to repair the leak. Meningitis occurred in four patients with clinically evident
CSF leak. Multiple skull base fractures are associated with poor neurological
outcome. The low rate of meningitis in this patient sample implies that there is
no indication to administer prophylactic antibiotics to patients with skull base
fractures. 

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