Cerebrospinal Fluid Leaks After Anterior Skull Base Trauma: A Systematic Review of the Literature
Autor: | Gianluca Scalia, Santino Ottavio Tomasi, Luca Ricciardi, Resi Pucci, Andrea Cassoni, Lidia Strigari, Giuseppe Emmanuele Umana, Paolo Palmisciano, Valentino Valentini |
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Rok vydání: | 2021 |
Předmět: |
Surgical repair
Skull Base medicine.medical_specialty Leak Cerebrospinal fluid leak medicine.diagnostic_test Anterior skull baseCerebrospinal fluid leakCraniofacial traumaEndoscopySkull base fracture Cerebrospinal Fluid Leak business.industry Fistula Endoscopy medicine.disease Skull Fracture Basilar Surgery Skull medicine.anatomical_structure Cerebrospinal fluid Cohort medicine Humans Neurology (clinical) business |
Zdroj: | World neurosurgery. 157 |
ISSN: | 1878-8769 |
Popis: | Background Anterior skull base (ASB) fractures are reported in 4% of head injuries and represent 21% of all skull fractures. Cerebrospinal fluid (CSF) leaks may follow, severely exacerbating outcomes. We systematically reviewed the literature to analyze and compare the roles of endoscopic surgery, open surgery, and combined approaches in the management of CSF leak repair after posttraumatic ASB fractures. Methods PubMed, Web of Science, and Scopus databases were searched in accordance with the PRISMA guidelines. Studies reporting clinical data of patients with CSF leaks after ASB fracture were reviewed, focusing on management strategies and posttreatment outcomes. Results We included 29 articles comprising 888 patients. The average age at diagnosis was 34 years (range, 18–91 years), with a male predominance (54%) and a male/female ratio of 2.9:1 (647:241). Clinical data were available for 888 patients with CSF leaks after ASB fracture, reporting a median follow-up time of 33.5 months (standard deviation, ±29; range, 0.5–330.0 months). Open surgical repair was the most common approach (67.9%), followed by endoscopic surgical repair (32.1%). The endoscopy cohort showed lower rates of complications (0.7% vs. 11.1%) and fistula recurrence (2.8% vs. 5.3%) compared with open surgery. Conclusions ASB fractures are frequently treated as late surgery, 24 hours from injury or later, especially for endoscopic surgery. Overall, the endoscopic approach is preferred, mostly because of its safety and effectiveness, offering lower failure rates than does open surgery. |
Databáze: | OpenAIRE |
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