Clinical Significance of Long-Term Follow-Up of Children with Posttraumatic Skull Base Fracture

Sharon Leibu, Guy Rosenthal, Yigal Shoshan, Mony Benifla

Research output: Contribution to journalArticlepeer-review

9 Scopus citations

Abstract

Objective To assess the incidence of cerebrospinal fluid (CSF) leak and meningitis, and the need for prophylactic antibiotics, antipneumococcal vaccination, and surgical interventions, in children with a skull base fracture. Methods We reviewed the records of children with a skull base fracture who were admitted to our tertiary care center between 2009 and 2014. Results A total of 196 children (153 males), age 1 month to 18 years (mean age, 6 ± 4 years), were hospitalized with skull base fracture. Causes of injury were falls (n = 143), motor vehicle accidents (n = 34), and other (n = 19). Fracture locations were the middle skull base in 112 patients, frontal base in 62, and occipital base in 13. Fifty-four children (28%) had a CSF leak. In 34 of these children (63%), spontaneous resolution occurred within 3 days. Three children underwent surgery on admission owing to a CSF leak from an open wound, 3 underwent CSF diversion by spinal drainage, and 4 (2%) required surgery to repair a dural tear after failure of continuous spinal drainage and acetazolamide treatment. Twenty-eight children (14%) received prophylactic antibiotic therapy, usually due to other injuries, and 11 received pneumococcal vaccination. Two children developed meningitis, and 3 children died. Long-term follow up in 124 children revealed 12 children with delayed hearing loss and 3 with delayed facial paralysis. Conclusions This is the largest pediatric series of skull base fractures reporting rates of morbidity and long-term outcomes published to date. The rate of meningitis following skull base fracture in children is low, supporting a policy of not administering prophylactic antibiotics or pneumococcal vaccine. Long-term follow up is important to identify delayed complications.

Original languageEnglish
Pages (from-to)315-321
Number of pages7
JournalWorld Neurosurgery
Volume103
DOIs
StatePublished - 1 Jul 2017
Externally publishedYes

Keywords

  • Meningitis
  • Prophylactic antibiotics
  • Skull base fracture
  • Traumatic brain injury
  • Vaccination

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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