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Basilar skull fractures in childhood with cranial nerve involvement
J L Kitchens1, D B Groff, H S Nagaraj
1Department of Surgery, University of Louisville School of Medicine, KY.
Insights
Pediatric basilar skull fractures frequently cause cranial nerve palsies, especially in older children. While many cases resolve, significant morbidity can occur in those with residual deficits, underscoring the need for careful prognosis discussions.
Area of Science:
- Pediatric neurosurgery
- Traumatic brain injury
Background:
- Basilar skull fractures in children can lead to serious complications.
- Understanding the incidence and outcomes of these fractures is crucial for pediatric care.
Purpose of the Study:
- To determine the incidence of cranial nerve palsies in children with basilar skull fractures.
- To evaluate the role of prophylactic antibiotics and steroid treatment in these cases.
- To analyze the prognosis and long-term outcomes for pediatric patients with basilar skull fractures.
Main Methods:
- Retrospective analysis of 73 pediatric patients with basilar skull fractures.
- Documentation of cranial nerve palsies, meningitis, and treatment interventions.
- Assessment of patient outcomes, including complete resolution and residual deficits.
Main Results:
- Cranial nerve palsies occurred in 23% of pediatric patients, predominantly in those aged 10 years and older.
- The incidence of meningitis was consistent with existing literature, suggesting avoidance of prophylactic antibiotics.
- No neurological improvement was observed with steroid treatment; one meningitis case was associated with steroids.
Conclusions:
- Cranial nerve palsies are a significant complication of pediatric basilar skull fractures, particularly in older children.
- Prophylactic antibiotics are not recommended, and steroid use appears unwarranted.
- While over half of cases resolve completely, residual deficits can lead to substantial morbidity, necessitating clear communication of prognosis with families.
Abstract:
Cranial nerve palsies developed in 23% of 73 children with basilar skull fractures. The majority occurred in patients 10 years of age or older. Our overall incidence was higher than that in a review in which basilar skull fractures were indiscriminately included with all head injuries. Our experience with meningitis was similar to that present in the literature and would seem to support avoidance of prophylactic antibiotics. Because there was no improvement in neurological deficits in patients treated with steroids (the only case of meningitis in our series was associated with steroids), we believe that their use is unwarranted. It is important to discuss the prognosis with the patient's family, because, although the majority (53.3%) of cases resolve completely, those with residual deficits can have significant morbidity.