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  Česky / Czech version Čes. a slov. Neurol. Neurochir., 68/101, 2005, No. 2, p. 102–107.
 
Timing of frontobasal trauma repair 
Kalita O., Kala M., Vaverka M., Houdek M. 

Neurochirurgická klinika FN a UP Olomouc
 


Summary:

       The paper presents the results of treatment of 165 patients with frontobasal injury who were hospitalized in our clinic from 1 January 1989 to 31 December 2002. The classic conservative treatment of frontobasal trauma involves bed rest for 3 weeks, followed by consideration of surgery. This treatment strategy is still being applied by some neurosurgeons. In cases of concomitant craniofacial surgery, the procedure consisted of three phases. The first period included craniotomy, revision of intracranial space, repair of dural tears, brain damage and bleeding. The second phase, 7 to 10 days later, included treatment of orbitofacial trauma. If needed, corrective plastic surgery was performed in 6 to 12 months. Our treatment strategy is early repair within 48 hours of injury. The aim is to take advantage of this time interval in order to repair dural tear in the anterior fossa and restore the anatomical relations of the skull before the development of traumatic brain edema, which minimizes the operative field. For concomitant facial injuries, we indicate early single-stage repair by a team including a neurosurgeon and a maxillary surgeon. In our patient group, 22 patients developed intracranial cerebral inflammations, 17 meningitis and 5 abscess. In the group treated with the traditional conservative approach 14 (45.1 %) patients developed meningitis. With the early repair approach, 1 (0.9 %) case of meningitis occurred. Five (18 %) cases of abscess developed in the postponed surgery patients. In our opinion, early and single-stage repair allows definitive treatment of dural tears and represents the only prevention of intracranial inflammatory complications. This procedure substantially decreases time spent in hospital, reduces the amount of operative procedures, accelerates healing, improves the final esthetic effect and reduces the possibility of complications that arise in such intricate regions in two-stage surgeries.

        Key words: frontobasal trauma, craniofacial trauma, early single-stage repair
       

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