Cerebrospinal fluid leak following traumatic skull base fractures: Predictors and outcomes

Traumatic skull base fractures carry a risk of cerebrospinal fluid (CSF) leak, predisposing patients to meningitis, neurological complications, and prolonged hospitalization. Predictive factors for posttraumatic CSF leak remain incompletely defined. The primary objective of this study is to identify clinical and radiological predictors of CSF leak among patients with traumatic skull base fractures and evaluate associated outcomes at a Level-1 trauma center.

A retrospective cohort study was conducted at King Abdulaziz Medical City, Riyadh, including all patients with computed tomography-confirmed skull base fractures from 2016 to 2024. Demographics, injury characteristics, management variables, and complications were extracted from the trauma registry and electronic medical records. Bivariate comparisons and logistic regression were performed to determine independent predictors of CSF leak.

Among 499 patients, 36 (7.2%) developed a CSF leak. Mixed temporal fractures and pneumocephalus were independent predictors of CSF leak. CSF leak was associated with significantly higher rates of meningitis (11.1% vs. 0.9%), cranial nerve deficits (19.4% vs. 4.8%), and internal carotid artery injury (13.9% vs. 3.7%) (all P < 0.05). Median hospital stay was longer in patients with CSF leak (23.5 vs. 14 days, P = 0.038).

Mixed temporal bone fracture patterns and pneumocephalus are strong predictors of posttraumatic CSF leak, while the presence of meningitis and cranial nerve deficits reflects more severe injury and increased morbidity. Structural fracture complexity and radiologic markers appear more informative than fracture location alone. Early recognition, risk-based monitoring, and timely multidisciplinary management are essential to mitigate infectious and neurological sequelae.