Clinical Significance of Long-Term Follow-Up of Children with Posttraumatic Skull Base Fracture.
World Neurosurg
; 103: 315-321, 2017 Jul.
Article
em En
| MEDLINE
| ID: mdl-28433849
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.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Temas:
Geral
Base de dados:
MEDLINE
Assunto principal:
Infecções Pneumocócicas
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Inibidores da Anidrase Carbônica
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Base do Crânio
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Fratura da Base do Crânio
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Vacinas Pneumocócicas
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Vazamento de Líquido Cefalorraquidiano
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Meningite
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Acetazolamida
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Antibacterianos
Tipo de estudo:
Etiology_studies
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Observational_studies
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Prognostic_studies
Limite:
Adolescent
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Child
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Child, preschool
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Female
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Humans
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Infant
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Male
Idioma:
En
Revista:
World Neurosurg
Assunto da revista:
NEUROCIRURGIA
Ano de publicação:
2017
Tipo de documento:
Article
País de afiliação:
Israel