Management of Traumatic Anterior Skull Base Fractures and Cerebrospinal Fluid Fistulas

Blunt trauma and falls from heights are the primary causes of skull base fractures, which comprise ∼20% of all skull fractures. One-third of these fractures lead to a cerebrospinal fluid (CSF) fistula, typically managed conservatively and without surgery.

The authors analyzed the factors affecting the formation and closure time of CSF fistulas.

The authors followed up 31 patients with traumatic anterior skull base fractures (ASBF) between November 15, 2020 and October 10, 2023. The clinical characteristics, tomography data, and occurrence of CSF fistulas were documented in these patients.

Motor vehicle accidents were the primary cause of admission for most of the 31 patients with anterior skull base fractures (ASBF) (71%, n=26). Rhinorrhea was observed in 9 patients (29.0%). ASBF were most commonly seen in compartment I, representing the frontal sinus region, in 24 patients (77.4%), followed by compartment III, representing the sphenoid sinus region, in 22 patients (71.0%), and compartment II, representing the fovea ethmoidalis and cribriform plate region, in 21 patients (67.7%). Although conditions such as skull base fracture displacement and the presence of pneumocephalus were numerically higher in the patient group with rhinorrhea, they were not statistically significant. In addition, the contribution of acetazolamide use and high body mass index values ​​to the development of rhinorrhea in traumatic anterior skull base fractures was not statistically significant.

Traumatic ASBF are complicated due to conditions such as CSF fistula, intracranial hemorrhage, and meningitis, and should be managed with a multidisciplinary approach. Traumatic anterior skull base fractures occur more frequently in compartment 1. Numerous factors may influence the formation and duration of posttraumatic CSF fistula, and these factors should be assessed in larger patient series.