University of Florida College of Medicine, Gainesville, FL, USA.
Rosalind Franklin University of Medicine and Science, Chicago, IL, USA.
Clin Neurol Neurosurg. 2022 Jun;217:107276. doi: 10.1016/j.clineuro.2022.107276. Epub 2022 May 2.
Cerebrospinal fluid (CSF) leak occurs most commonly following skull fracture, with a CSF leakage complicating up to 2% of all head traumas. This study aims to identify demographic and injury characteristics correlated with the highest risk of CSF leak in patients with known facial fractures.
Retrospective data was collected from a previously described trauma registry from 2010 to 2019. Patients over 18 years old with any type of facial fracture, known CSF leak status, available neuroimaging, and hospital admission were included. Chi-Square analysis for demographic and injury characteristic data were utilized.
A total of 79 patients with CSF leak and 4907 patients without CSF leak were included in the database. Patients with CSF leak tended to be younger than those without CSF leak (38.45 +/- 0.28 vs 44.08 +/- 0.28, M +/- SE, p = 0.0197). CSF leak depended on the mechanism of injury (MOI; X =27.02, df=2, p = 0.0000013), with CSF leak rates highest in penetrating injuries (4.87%) and motor vehicle accidents (1.78%) compared to blunt injuries (0.95%); age did not significantly differ between the MOI groups (p = 0.11). CSF leak was also more common in patients with a lower Glasgow coma scale (GCS; 7.95 +/- 0.58 vs 12.21 +/- 0.10, p = 10), LeFort type 2&3 and pan-facial fractures compared to all other facial fracture types (8.9% vs 1.2%, p = 10), and radiographic midline shift (29.4% vs 9.1%, p = 10). There was a trend towards a higher proportion of males in those with CSF leak compared to those without (83.3% vs 73.7% males, p = 0.073), and in patients with prolonged loss of consciousness (LOC; 9.43% with LOC > 1 h vs 2.69% LOC < 1 h, p = 0.056).
Facial fractures often present with CSF leak, and certain demographic and injury risk factors including younger age, worse GCS score, evidence of midline shift, and certain mechanisms of injury (penetrating and motor vehicle) are correlated with increased risk and warrant close screening and follow-up for CSF leak detection. LeFort type 2&3 and pan-facial fractures are at high risk of CSF leak.
脑脊液（CSF）漏最常发生于颅骨骨折后，高达 2%的颅脑外伤合并 CSF 漏。本研究旨在确定与已知面骨骨折患者 CSF 漏风险最高相关的人口统计学和损伤特征。
回顾性数据来自 2010 年至 2019 年描述的创伤登记处。纳入年龄大于 18 岁、有任何类型面骨骨折、已知 CSF 漏状态、有神经影像学和住院记录的患者。采用卡方分析对人口统计学和损伤特征数据进行分析。
数据库中共有 79 例 CSF 漏患者和 4907 例无 CSF 漏患者。与无 CSF 漏患者相比，CSF 漏患者年龄较小（38.45±0.28 岁 vs 44.08±0.28 岁，M+/-SE，p=0.0197）。CSF 漏与损伤机制（MOI；X=27.02，df=2，p=0.0000013）有关，穿透伤（4.87%）和机动车事故（1.78%）的 CSF 漏发生率高于钝伤（0.95%）；MOI 组之间年龄无显著差异（p=0.11）。CSF 漏在格拉斯哥昏迷评分（GCS）较低的患者中也更为常见（7.95±0.58 分 vs 12.21±0.10 分，p=10），与所有其他面骨骨折类型相比，LeFort 2&3 型和全颜面骨折更为常见（8.9% vs 1.2%，p=10），影像学中线移位（29.4% vs 9.1%，p=10）。与无 CSF 漏患者相比，CSF 漏患者中男性比例更高（83.3% vs 73.7%男性，p=0.073），且昏迷时间延长（9.43%的患者 LOC>1 小时，2.69%的患者 LOC<1 小时，p=0.056）。
面骨骨折常伴有 CSF 漏，某些人口统计学和损伤危险因素，包括年龄较小、GCS 评分较低、中线移位证据以及某些损伤机制（穿透伤和机动车事故）与更高的风险相关，需要密切筛查和随访以检测 CSF 漏。LeFort 2&3 型和全颜面骨折发生 CSF 漏的风险较高。
