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        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Las f&#237;stulas traum&#225;ticas de LCR aparecen en un 511&#37; de pacientes con fractura demostrada de base de cr&#225;neo&#46; El riesgo potencial de las mismas es el desarrollo de meningitis postraum&#225;tica&#46; La prevenci&#243;n de la meningitis se basa en la reparaci&#243;n quir&#250;rgica de la f&#237;stula cuando las medidas conservadoras no lo consiguen&#46; Se han propuesto diversas t&#233;cnicas de cierre&#44; con una cifra de recidiva de f&#237;stula y&#47;o meningitis de hasta el 25&#37; seg&#250;n los autores&#46; Analizamos nuestros resultados&#44; en t&#233;rminos de cese de la rinorrea y desaparici&#243;n de nuevos episodios de meningitis&#44; en una serie consecutiva de 56 pacientes intervenidos en la CSUB entre 1987 y 1998 con la realizaci&#243;n de un abordaje bifrontal intradural con exploraci&#243;n de la totalidad de la fosa anterior y recubrimiento de &#233;sta con un colgajo pediculado de pericr&#225;neo&#46; Todos los pacientes fueron estudiados mediante TAC craneal con cortes axiales y coronales prescindiendo de forma deliberada de otras t&#233;cnicas de imagen para la localizaci&#243;n de la f&#237;stula&#46; Con un seguimiento de entre 1 y 11 a&#241;os &#40;media 5&#46;6 a&#241;os&#41; no se ha detectado ning&#250;n caso de recidiva de f&#237;stula ni nuevos episodios de meningitis&#46; La mortalidad operatoria fue nula y s&#243;lo dos pacientes presentaron anosmia tras la cirug&#237;a&#46; La exploraci&#243;n quir&#250;rgica bilateral de la fosa anterior y su tapizado completo con un colgajo pediculado permite un sellaje y separaci&#243;n definitivas entre la cavidad craneal y las cavidades nasosinusales&#46; El uso de abordajes unilaterales y el uso de tejidos no vascularizados debe ser evitado en el manejo de esta patolog&#237;a&#46;</p>"
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        "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Between 5&#8211;11&#37; of patients harboring skull base fractures may present with cerebrospinal fluid &#40;CSF&#41; fistula&#46; Their risk is the development of posttraumatic meningits&#46; Surgical repair of the dural defect&#44; when conservative measures fail&#44; is mandatory in order to avoid new episodes of meningitis&#46; Several surgical procedures have been proposed with an overall failure rate around 25&#37;&#46; Between 1987&#8211;1998 we treated 56 patients with posttraumatic CSF fistula and&#47;or posttraumatic meningits with a bifrontal craniotomy&#44; intradural exploration and carpeting of the anterior fossa with a pediculated pericranial flap&#46; All patients underwent preoperative axial and coronal CT-scan and deliberately we did not use other imaging techniques to 10calize the fistula&#46; After a follow-up of 1&#8211;11 years &#40;mean 5&#46;6 y&#41; no recurrent episodes of meningitis or rhinorrhea have been detected&#46; There was not operative mortality and 2 patients developped anosmia after the surgical procedure&#46; A bilateral surgical exploration and complete covering of the anterior fossa floor with a pediculated pericranial flap allows a safe sealing as well as an effective isolation between anterior fossa and paranasal cavities&#46; Unilateral approaches as well as nonvascularized materials should be avoided in the management of these patients&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara">Acebes&#44; J&#46;J&#46;&#59; Cabiol&#44; J&#46;&#59; L&#243;pez-Obarrio&#44; L&#46;&#59; Serra&#44; J&#46;M&#46;&#59; Gabarr&#243;s&#44; A&#46;&#59; Isamat&#44; F&#46;&#58; Craniotom&#237;a bifrontal y colgajo pediculado de pericr&#225;neo en el tratamiento de las f&#237;stulas traum&#225;ticas de LCR&#46; Neurocirug&#237;a 1999&#59; 10&#58; 445&#8211;452&#46;</p>"
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                            4 => "L&#46; Wid&#233;n"
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                      "titulo" => "The galea frontalis myofascialis flap in anterior fossa CSF leaks"
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                      "titulo" => "CSF rhinorrhea&#58; detection and localization using overpressure cisternography with Tc-99<span class="elsevierStyleHsp" style=""></span>m-DTPA"
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Vol. 10. Núm. 6.
Páginas 445-452 (enero 1998)
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Vol. 10. Núm. 6.
Páginas 445-452 (enero 1998)
Craneotomía bifrontal y colgajo pediculado de pericráneo en el tratamiento de las fístulas traumáticas de LCR
Bifrontal craniotomy and pediculated pericranial flap in the management of traumatic fistula
Visitas
3561
J.J. Acebes, J. Cabiol, L. López-Obarrio, A. Gabarrós, F. Isamat
Servicios de Neurocirugía Ciutat Sanitaria i Universitaria de Bellvitge. Barcelona
J.M. Serra*
* Servicios de Cirugía Plástica Ciutat Sanitaria i Universitaria de Bellvitge. Barcelona
Este artículo ha recibido
Información del artículo
Resumen

Las fístulas traumáticas de LCR aparecen en un 511% de pacientes con fractura demostrada de base de cráneo. El riesgo potencial de las mismas es el desarrollo de meningitis postraumática. La prevención de la meningitis se basa en la reparación quirúrgica de la fístula cuando las medidas conservadoras no lo consiguen. Se han propuesto diversas técnicas de cierre, con una cifra de recidiva de fístula y/o meningitis de hasta el 25% según los autores. Analizamos nuestros resultados, en términos de cese de la rinorrea y desaparición de nuevos episodios de meningitis, en una serie consecutiva de 56 pacientes intervenidos en la CSUB entre 1987 y 1998 con la realización de un abordaje bifrontal intradural con exploración de la totalidad de la fosa anterior y recubrimiento de ésta con un colgajo pediculado de pericráneo. Todos los pacientes fueron estudiados mediante TAC craneal con cortes axiales y coronales prescindiendo de forma deliberada de otras técnicas de imagen para la localización de la fístula. Con un seguimiento de entre 1 y 11 años (media 5.6 años) no se ha detectado ningún caso de recidiva de fístula ni nuevos episodios de meningitis. La mortalidad operatoria fue nula y sólo dos pacientes presentaron anosmia tras la cirugía. La exploración quirúrgica bilateral de la fosa anterior y su tapizado completo con un colgajo pediculado permite un sellaje y separación definitivas entre la cavidad craneal y las cavidades nasosinusales. El uso de abordajes unilaterales y el uso de tejidos no vascularizados debe ser evitado en el manejo de esta patología.

Palabras clave:
Traumatismo craneoencefálico
Fractura craneal
Meningitis postraumática
Rinorrea
Craneotomía bifrontal
Injerto
Anosmia
Abstract

Between 5–11% of patients harboring skull base fractures may present with cerebrospinal fluid (CSF) fistula. Their risk is the development of posttraumatic meningits. Surgical repair of the dural defect, when conservative measures fail, is mandatory in order to avoid new episodes of meningitis. Several surgical procedures have been proposed with an overall failure rate around 25%. Between 1987–1998 we treated 56 patients with posttraumatic CSF fistula and/or posttraumatic meningits with a bifrontal craniotomy, intradural exploration and carpeting of the anterior fossa with a pediculated pericranial flap. All patients underwent preoperative axial and coronal CT-scan and deliberately we did not use other imaging techniques to 10calize the fistula. After a follow-up of 1–11 years (mean 5.6 y) no recurrent episodes of meningitis or rhinorrhea have been detected. There was not operative mortality and 2 patients developped anosmia after the surgical procedure. A bilateral surgical exploration and complete covering of the anterior fossa floor with a pediculated pericranial flap allows a safe sealing as well as an effective isolation between anterior fossa and paranasal cavities. Unilateral approaches as well as nonvascularized materials should be avoided in the management of these patients.

Key words:
Head injury
Skull base fracture
Posttraumatic meningits
Rhinorrhea
Anosmia
Bifrontal craniotomy

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