Liquorhoea—Conservative or Surgery, or Both of Them Is True?

Our group has more than 493 patients: the anterior skull base, middle, posterior open trauma. During anterior skull base reconstruction we protected the olfactory structures in 91%. Mortality v our series is 1.7%, morbidity posttraumatic 17%, postoperative 0,6%.

Follow-up in this series is 27 years.

In our series, we preferred acute operations and reconstructions of open skull base fracture with very effective goal. In reconstruction method, we preferred vascularized flaps for reconstruction of dura. Author discussed problems of acute and delay reconstruction, discussed mortality and morbidity. Authors have experiences 27 years with acute operations and reconstructions, diagnostic technics, treatment, and follow-up of patients.

Concurrently with timing surgery study of open skull base fracture, we have constituted group nonsurgery treatment open skull base fracture. Our study group have together 116 cases, which come into being first 5 years. We have follow-up of the group 20 years. We were all eyes on complications, which developing during 15 to 20 years under different diagnosis: meningitis, meningoencephalitis, abscessus cerebri, liquorrhea, pneumocephalus, Pott's tumor, mucocele, meningoencephalocele, “polyps of paranasal sinuses,” “polyps of middle ear,” and “cholesteatoma of middle ear.”

The criteria— our characteristics of choices to the nonsurgery group: only intradural pneumocephalus intradural pneumocephalus and liquorrhea, which stop during 24 to 48 hours only liquorrhea, which stop during 24 to 48 hours.

The first group have maximum between half and 1 year after trauma after diagnosis (15.5%), the second group between 5 and 6 years (12.1%), the third group between 11 and 13 years, (13.9%) and forth group between 16 and 18 years. (9.4%).

We need to do exchanges conservative treatment to surgery treatment in 58.6% during 20 years. under different diagnosis. If became the diagnosis after trauma late, the diagnosis have not immediate relation to traumatic diagnosis.

We study different pathological problems posttraumatic on olfactory structures - destruction or contusion or hematoma into olfactory bulb, destruction of olfactory tract and destruction or contusions in olfactory trigonum.

In lecture author will be discussed about new anatomical aspect of skull base, the biomechanical aspect of dura mater, the technical notes of different approaches of reconstruction, problems of timing of reconstruction or the controversies between conservative and surgery treatment.

In our series, we preferred acute operations and reconstructions of open skull base fracture with very effective goal. In reconstruction method, we preferred vascularized flaps for reconstruction of dura. Author discussed problems of acute and delay reconstruction, discussed mortality and morbidity. Authors have 27 years of experiences with acute operations and reconstructions, diagnostic technics, treatment, and follow-up of patients.