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Abstract

REALITY OF TAKING CARE OF CEREBROSPINAL FLUID FLOW ON FRACTURES OF THE ANTERIOR FLOOR OF THE SKULL BASE

Maholisoa Patrick Randrianandraina*, Willy Francis Rakotondraibe, Léandre Sylvestre Haminason, Willy Ratovondrainy, Mamiarisoa Rabarijaona, John Alberto Bam Razafindrabe and Clément Andriamamonjy

ABSTRACT

Introduction: Trauma of the anterior stage of the skull base threaten the overlying neuroencephalic structures and are very often responsible for osteomeningeal breaches exposing to the risk of intra cranial infections. Objective: To give an epidemiological and clinical overview of cerebrospinal rhinorrhea on a fracture of the anterior stage of the skull base and to report its management. Methods: This is a retrospective monocentric study carried out in the neurosurgery department of the Joseph Ravoahangy Andrianavalona University Hospital of Antananarivo, Madagascar between January 2012 and December 2015. We collected patients operated on for an osteodural breach on a fracture of the anterior stage of the skull base. Results: Twenty patients represents 0.65% of 3100 Head trauma were operated for osteomeningeal breach on anterior floor fracture. The average age was 30 years with extremes from 20 years to 52 years. The sex ratio was 4H / 1F. Accidents on the public highway represent the most frequent etiology with 65% of cases. The clinical examination noted a periorbital bruise in 75% of patients, an epistaxis in 70% of patients and rhinorrhea in 40% of patients. Brain CT was performed in all of our patients, and made it possible to diagnose the breach in 80% of cases. The ethmoidal localization was the most frequent (85%). All the patients benefited from a surgical closure of their breach by bilateral frontal approach. The evolution was favorable in 90% of patients. Conclusion: Any post-traumatic rhinorrhea requires systematic exploration. The ideal timing is the disappearance of the cerebral edema to facilitate exploration, this is generally possible from the 72nd hour.

Keywords: Head trauma, cerebrospinal rhinorrhea, anterior stage.


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