Erfahrungen mit dem subfrontalen Zugang zur Rekonstruktion ausgedehnter Frakturen im Bereich der Frontobasis

Background: Surgical management of multiple traumatized patients with head and neck trauma is highly individualized and depends on a number of factors including etiology, intracranial pressure, concomitant injuries, patient age and the possibility of an interdisciplinary procedure. Severe head and neck trauma are often connected with fractures of the frontal skullbase or naso-ethmoido-orbital complex and CSF leakage. If there is suspicion of a CSF leakage surgical management to cover the dura-defect is essential. An intradural approach is nessecary in case of concomitant intradural injuries while primary extradural access provides excellent exposure of the rhinobasis with low morbidity and good results. Methods and Material: We report about our surgical experiences of 55 patients with severe frontobasal trauma, who were operated between 1/1999 and 11/2003. The subfrontal approach according to Raveh we had chosen in 20 patients which were operated by an interdisciplinary team together with the neurosurgeons. With an average follow up of 36 month we report about early and late complications. Results: 19/20 patients showed sufficient coverage of the CSF leakage, once a revision surgery was nessesary. Finally this patient had also an unobjectionable coverage of the CSF leakage. We saw no major complication like meningitis or brain abscess, intracerebral haematoma or surgical injury of the orbital wall. The most important complication was an anosmia, which depending on the extension of the approach results in any patients. Conclusions: Our results show that the subfrontal approach is a reliable method to explore extensive frontal dural defects and to reconstruct fractures of the frontal skull base without additional trauma to the frontal lobe.