Fritz Christian, Harris Jacob, De Ravin Emma, Xu Katherine, Parhar Harman S, Davis Lauren, Moreira Alvaro, Rajasekaran Karthik
Department of Otorhinolaryngology - Head & Neck Surgery, University of Pennsylvania.
Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
J Craniofac Surg. 2023;34(5):1393-1397. doi: 10.1097/SCS.0000000000009279. Epub 2023 Mar 14.
Cerebrospinal fluid (CSF) leaks are a complication from dural violations that can occur in the setting of skull base fractures. No prior study provides a nationwide epidemiological analysis of traumatic CSF leaks. The objective of this report is to characterize patient demographics, injury-related variables, and operative management.
The national trauma data bank was queried for both anterior and lateral skull base fracture cases between 2008 and 2016. Clinical data were extracted.
A total of 242 skull base fractures with CSF leak were identified. Most patients were male (84.3%), and the median patient age was 39.7±17.6 years old. Glasgow Coma Scale was 14.0 [interquartile range (IQR): 6.5-10.6] for lateral fractures, 13.0 (IQR: 3.0-10.0) for anterior fractures, and severe range for combined fractures at 7.0 (IQR: 5.0-9.0) (analysis of variance, P =0.122). Common mechanisms of injury were motor vehicle accidents (107, 44.2%), followed by falls and firearms (65, 26.9% and 20, 8.3%, respectively). The median length of stay was 2 weeks, with a median of 14 days (IQR: 10-25) for the anterior fractures and 10 days (IQR 5-19) among the lateral fractures ( P =0.592). Patients were most commonly discharged home in both the anterior (43.8%) and lateral (49.2%) groups.
The prototypical patient tends to be a young adult male presenting with moderate-to-severe range neurological dysfunction after a vehicular accident. The overall prognosis of skull base fractures with CSF leak remains encouraging, with nearly half of these patients being discharged home within 2 weeks.
脑脊液漏是硬脑膜破损的一种并发症，可发生于颅底骨折的情况下。此前尚无研究对创伤性脑脊液漏进行全国性的流行病学分析。本报告的目的是描述患者的人口统计学特征、损伤相关变量及手术治疗情况。
查询国家创伤数据库中2008年至2016年间的前颅底和侧颅底骨折病例，并提取临床数据。
共识别出242例伴有脑脊液漏的颅底骨折。大多数患者为男性（84.3%），患者中位年龄为39.7±17.6岁。侧颅底骨折患者的格拉斯哥昏迷量表评分为14.0[四分位数间距（IQR）：6.5 - 10.6]，前颅底骨折患者为13.0（IQR：3.0 - 10.0），合并骨折患者处于严重范围，评分为7.0（IQR：5.0 - 9.0）（方差分析，P = 0.122）。常见的损伤机制为机动车事故（107例，44.2%），其次是跌倒和火器伤（分别为65例，26.9%和20例，8.3%）。中位住院时间为2周，前颅底骨折患者的中位住院时间为14天（IQR：10 - 25），侧颅底骨折患者为10天（IQR 5 - 19）（P = 0.592）。在前颅底骨折组（43.8%）和侧颅底骨折组（49.2%）中，患者最常出院回家。
典型患者往往是年轻成年男性，在机动车事故后出现中度至重度神经功能障碍。伴有脑脊液漏的颅底骨折总体预后仍然令人鼓舞，近一半的此类患者在2周内出院回家。
