Piccirilli Manolo, Anichini Giulio, Cassoni Andrea, Ramieri Valerio, Valentini Valentino, Santoro Antonio
Department of Neurological Science, Neurosurgery, University of Rome "Sapienza," Rome, Italy.
J Neurol Surg B Skull Base. 2012 Aug;73(4):265-72. doi: 10.1055/s-0032-1312715.
Objective Frontobasal fractures are relatively common traumas but surgical indications are still discussed. The authors report their results on patients showing anterior cranial fossa fractures; clinical data, surgical indications, and results are reported and critically analyzed. Methods From 1991 to 2010, 223 patients were admitted in our institution with diagnosis of anterior cranial fossa fracture. Fractures were classified as type A-fracture of the anterior wall of the frontal sinus; type B-fracture of the posterior wall of the frontal sinus; and type C-frontobasal traumas without involvement of the frontal sinus. All patients entered a follow-up program consisting in periodic controls. Results A total of 105 patients were conservatively treated, while 118 patients underwent surgical intervention. The presence of pneumocephalus (p < 0.0001) and rhinoliquorrhea (p = 0.001) were the factors influencing the surgical indication. In the fractures of group B with signs of pneumocephalus and or rhinoliquorrhea, full sinus cranialization represents the variable mainly influencing the outcome (p < 0.001). Conclusion Patients with frontobasal traumas should be carefully evaluated to choose the best treatment option. Clinical and radiological data suggest that patients with frontobasal fractures with massive pneumocephalus and/or rhinoliquorrhea should be always surgically treated.
额底骨折是相对常见的创伤，但手术指征仍存在争议。作者报告了他们对前颅窝骨折患者的治疗结果；报告并批判性分析了临床数据、手术指征和结果。方法：1991年至2010年，223例患者因前颅窝骨折入院。骨折分为A类——额窦前壁骨折；B类——额窦后壁骨折；C类——不涉及额窦的额底创伤。所有患者均进入包含定期检查的随访计划。结果：105例患者接受保守治疗，118例患者接受手术干预。存在气颅（p＜0.0001）和脑脊液鼻漏（p = 0.001）是影响手术指征的因素。在伴有气颅和/或脑脊液鼻漏体征的B组骨折中，全鼻窦颅化是主要影响预后的变量（p＜0.001）。结论：应对额底创伤患者进行仔细评估，以选择最佳治疗方案。临床和影像学数据表明，伴有大量气颅和/或脑脊液鼻漏的额底骨折患者应始终接受手术治疗。
