Surgical treatment of traumatic injuries of the cranial base

Skull-base fractures involve one or more of the cribriform plate of the ethmoid bone, orbital plate of the frontal bone, sphenoid bone, occipital bone, and petrous or temporal bone. Although the fractures themselves only require reduction and reconstruction when the skull base is severely comminuted and altered, even small fractures and the traumatic shear forces can create tears in the meninges and thus predispose to cerebrospinal fluid leaks. This article explores the preoperative, intraoperative, and postoperative management of skull-base fractures, which most commonly involves resolution of the cerebrospinal fluid leak and the prevention of future leaks or meningoencephaloceles.