[Surgery of anterior skull base fractures]

The medical records of 144 patients that underwent surgery due to fractures of the anterior skull base between 1990 and 1999 were assessed retrospectively. Fracture causes, symptoms, fracture lines, surgical approaches and materials for dura repair were analyzed.

The most frequent fracture causes were automobile (46.1%), recreational (24.8%) and occupational accidents (16.3%). While a decrease in automobile accidents was observed from 1996 (71.4%) to 1999 (33.3%), an increase in sports accidents was documented from 1990 (5.3%) to 1999 (16.7%). The most common accompanying injuries were CSF leakage (38.9%), loss of vision (28.5%) and intracranial bleeding (21.5%). The roof of the ethmoid sinus (79.7%) and the frontal sinus (anterior and posterior wall) (73.6%) were fractured most commonly. The lamina cribrosa was involved in 32.6%, the sphenoid sinus in 29.2% of the fractures. Most commonly the bitemporal Unterberger approach (75.7%) was used. To a lesser degree the uni- (13.9%) or bilateral (4.8%) Kilian approach, the reopening of the old wound (4.2%) and the endonasal approach (1.4%) were utilized. Conserved dura was applied for the closure of CSF leaks in 80.7%, periostal flaps in 20.7%, fascia lata in 14.8% and TachoComb in 8.2%.

The results of this study indicate that posttraumatic fractures of the anterior skull base are declining in frequency. The most common causes for these injuries were automobile accidents but increasingly sports accidents. Typical fracture lines or combinations were not observed. In the period observed the bitemporal Unterberger approach and resorbable implant materials such as the coated collagen fleece TachoComb were increasingly used for surgery.