Skull base fracture treatment [Neurosurgery Wiki]

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====== Skull base fracture treatment ======

===== NG tubes =====

✖ Caution: cases have been reported with [[Skull base fracture]] where an NG tube has been passed intracranially through the fracture and is associated with fatal outcome in 64% of cases. Possible mechanisms include a [[cribriform plate]] that is thin (congenitally or due to chronic [[sinusitis]]) or fractured (due to a frontal basal skull fracture or a comminuted fracture through the [[skull base]]).

Suggested contraindications to the blind placement of an NG tube include trauma with a possible basal skull fracture, ongoing or history of previous CSF rhinorrhea, [[meningitis]] with chronic sinusitis.

===== Prophylactic antibiotics/vaccination =====

[[Prophylactic antibiotics for skull base fracture]]



===== Treatment =====
 
Most do not require treatment by themselves. However, conditions that may be associated with BSF that may require specific management include:

1. “traumatic aneurysms” 

2. posttraumatic [[carotid-cavernous fistula]] 

3. CSF fistula: operative treatment may be required for persistent CSF rhinorrhea; see CSF fistula (cranial)

4. meningitis or cerebral abscess: may occur with BSF into air sinuses (frontal or mastoid) even in the absence of an identifiable Cerebrospinal fluid fistula. May even occur many years after the BSF was sustained; see Post craniospinal trauma meningitis / posttraumatic meningitis 

5. cosmetic deformities

6. posttraumatic facial palsy