[Post-traumatic cerebrospinal rhinorrhea].

PURPOSE: Since frontobasal fractures after severe head trauma may cause serious late-term complications such as meningitis, their recognition and operative treatment are essential. Therefore, we analysed the importance of rhinoliquorrhoea as an early symptom of such fractures by comparison with neuroradiological methods. MATERIAL AND METHODS: In all patients undergoing operative revision of frontobasal fractures during a 7-year period, the clinical symptoms, results of neuroradiological examinations, concomitant injuries, as well as operative results, were studied retrospectively. RESULTS: 45 patients out of 688 with severe head injury showed frontobasal fractures (6.5%). The most common cause of these injuries were traffic accidents (55%) and precipitated falls or plunges (35%). Posttraumatic rhinoliquorrhoea was seen in 41 of 45 patients (91%), and 30 showed external periorbital injuries (66%). In 8 patients (18%) the frontobasal fractures could not be visualised by facultatively performed neuroradiological methods (coronary CT-scan, CT-cisternography, subarachnoid space scintigraphy). 15 patients (33%) were secondarily transferred to our institution, two of them more than two years after the causative injury. All patients were operated on successfully within 14 days after admission. CONCLUSION: Traffic accidents and precipitated falls or plunges are the main causes of head injuries with frontobasal fractures and about 2/3 of these patients show external periorbital injuries. Rhinoliquorrhoea as an early symptom allows diagnosis of frontobasal fractures in 90% of all cases rather than neuroradiological methods which failed to demonstrate frontobasal fractures in about 20% of our patients. Therefore, recognition of rhinoliquorrhoea in patients with severe head injury is essential.