ABSTRACT
Objective To investigate the technique and outcome of primary management of skull base fracture and cerebrospinal fluid (CSF) leakage by emergency surgery in patients with severe craniocerebral trauma. Methods A total of 16 patients with severe brain injury, skull base fracture and CSF leakage hospitalized in Department of Neurosurgery, Tianjin Medical University General Hospital from January 2014 to December 2015 were retrospectively analyzed. All of patients underwent emergency surgery to remove the hematoma and repair the skull base fracture, including anterior skull base repair in 12 patients and middle temporal skull base repair in 4 patients. During the surgery, the inner wall of the frontal sinus was managed by electrocautery, then removal of frontal sinus mucosa, hydrogen peroxide and iodophor rinse were used. The repairing and forming of the orbital roof were performed for the severe deformation cases. All bone fractures and fissures were filled with muscle blocks and biological glue and covered with a pedicled muscle flap. In addition, after close suturing of epidural, the intact periosteum under the skin flap was used to tile the skull base. No external material was used in the whole process. Results Among the 16 patients, 14 (87.5%) patients were successfully repaired by emergency surgery, and 2 cases (12.5%) failed. One of the patients who failed to repair the fracture was with the middle skull base fracture, severe fracture of skull base and mastoid, and extensive exposure of mastoid air chamber with large bone mass. This patient failed secondary surgical repair and died with severe infection. Another one case who failed primary surgery was with severe bone fractures in the anterior, middle and posterior skull base, which could not be completely repaired. This patient was also combined with infection and dead ultimately. Conclusion Primary repair in patient with severe head injury combined with skull base fracture, which needs surgical intervention can reduce further injury and save the patient's life. The key to the operation is to determine the operative principle and to repair the skull base tightly.