CSF Fistulas Following Frontal Sinus Fractures
CSF Fistulas Following Frontal Sinus Fractures
There appears to be multiple instances of Class II and III evidence that frontal sinus cranialization is an effective treatment of fractures when a CSF fistula is present, and obliteration is useful for nasofrontal tract outflow involvement. There appears to be no definitive evidence regarding the timing of surgery related to complication rates. There also appears to be no evidence that a CSF fistula is prevented with one type of surgery versus another; the vast majority of patient series report an algorithm that utilizes frontal sinus cranialization in these cases. No definitive evidence supports prophylactic antibiotic use. Further prospective, randomized trials and experiences from high-volume trauma centers will prove useful in determining the most efficacious means to manage this heterogeneous entity.
Conclusions
There appears to be multiple instances of Class II and III evidence that frontal sinus cranialization is an effective treatment of fractures when a CSF fistula is present, and obliteration is useful for nasofrontal tract outflow involvement. There appears to be no definitive evidence regarding the timing of surgery related to complication rates. There also appears to be no evidence that a CSF fistula is prevented with one type of surgery versus another; the vast majority of patient series report an algorithm that utilizes frontal sinus cranialization in these cases. No definitive evidence supports prophylactic antibiotic use. Further prospective, randomized trials and experiences from high-volume trauma centers will prove useful in determining the most efficacious means to manage this heterogeneous entity.
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