gms | German Medical Science

Objective: Surgery for frontobasal injuries is subject to an ongoing debate on appropriate timing, best surgical procedure and necessity of prophylactic antibiotics. We evaluated the long-term outcome of patients who underwent surgery for frontobasal injuries.

Methods: The charts of 67 consecutive patients, who underwent surgical treatment for frontobasal injuries from 1996 to 2005 were analyzed. Preoperative management consisted in prophylactic administration of antibiotics at least until surgery. Surgery was postponed until patients had emerged from coma and appeared to be clinically stable in regard to their multiple injuries. Surgical repair was achieved with craniotomy, followed by a combined extra-/intradural approach to the anterior skull base and sealing of dural lesions with free or pedicled subgaleal flaps. Information on follow-up was obtained by a telephone interview and/or questionnaire between July and November 2006. Long-term outcome was assessed with data on patients' impairment, ability to work and symptoms of potentially persistent CSF leakage.

Results: Follow-up data was obtained from 46 patients, showing good or excellent long-term outcome in 34 cases. At follow-up, 41 patients negated signs of rhinorrhea and/or neck stiffness. 5 patients reported such signs but did not want further clarification. 4 patients died before follow-up, whereas intracranial infection did not cause death in any of them.

Conclusions: The applied regimen results in good or excellent long-term outcome in the majority of cases. As this may possibly also be achieved without the administration of antibiotics prior to surgery, a prospective double blind study may well be warranted.