Fractures of the floor of the anterior cranial fossa the selection of patients for dural repair

1. A series of 87 patients operated on because of subfrontal fractures is reported. In 73 of these a fistulous lesion (connecting the brain with the nose or the accessory air sinuses) was displayed and was repaired. Almost always a bifrontal exploration has been made, because the lesions were bifrontal in 43 per cent of cases. The mean follow-up period was 4 years; to date no instances of postoperative meningitis or rhinorrhoea have occurred. 2. Our experience suggests that cerebrospinal rhinorrhoea accompanying fractures of the facial bones (without fractures of the skull vault) can safely be treated conservatively. 3. Damaged brain adheres to the lips of the torn dura and permanently prevents natural healing, thereby creating a continuing threat to life. Consequently it is recommended that all frontal fractures lying below the hairline and all comminuted anterior temporal fractures should be referred for expert neurosurgical/neuroradiological assessment. This is because 42 per cent of the patients requiring operative repair were selected after tomographic studies of the anterior fossa; they had not presented with the classic criteria of cerebrospinal rhinorrhoea, intracranial air, or meningitis.