Management of anterior skull base fracture: experience of the neurosurgery department of the teaching hospital of Bouaké

Abstract

Objective
To report the experience of the Neurosurgery department of the teaching Hospital of Bouaké in the management of anterior skull base fractures.
Methodology
We carried out a descriptive retrospective study involving 60 patients hospitalized from January 1, 2016 to December 31, 2019 in the Neurosurgery Department of the teaching hospital of Bouaké for the management of anterior skull base fracture confirmed by CT scan. The parameters studied were: age, sex, circumstances of occurrence, clinical signs, treatment and outcome.
Results
Patients with anterior skull base fracture accounted for 18.5% of patients hospitalized for head trauma. Their mean age was 25 years and there was a male predominance (90%). Road accidents were the most common occurrence (78.4%). Disturbance of consciousness was observed in 70% of patients. Cerebrospinal rhinorrhea was authenticated in 28.3% of patients, periorbital ecchymosis in 80% and craniofacial wound in 58.3% of cases. The most frequent anatomoclinical form was represented by mid-facial fractures (54%) followed by mid-craniofacial forms (28%). The CT scan revealed associated lesions such as pneumocephaly (71.2%), cerebral contusion (48.3%), extradural hematoma (20%) and acute subdural hematoma (10%). From a therapeutic standpoint, 42% of patients had neurosurgical treatment. The osteomeningeal breach was the main indication for surgery (60% of operated). The outcome was good in 96,6% of all patients.
Conclusion
Anterior skull base fracture is a particular entity of head trauma. They are much more common in young male victims of public road accident. Head CT scan occupies a prominent place for the positive diagnosis, however the topographic diagnosis of Osteo-meningeal Breach which makes the severity of anterior skull base fracture remains sometime difficult. Their prognosis is usually good despite the significant bone damage encountered.