Base of Skull Fracture

Hi All,

I am going to share with you some knowledge which I have learnt for the last four weeks in neurosurgery ward. They are as follows:

Base of Skull (BOS) Fracture

1) Most common clinical features are blood or CSF from ear or nose

2) Those patient with CSF leakage may complain of a salty tasting fluid running down the back of throat

3) Patient has BOS fracture with CSF leak is far more severe and potentially life threatening when compare to patient who only has BOS fracture

4) Two main complications for BOS fracture with CSF leak are:
- Cerebral Infection ( Particular bacterial meningitis)
- Pneumocephalus( Accumulation of air in cranium)

5) Medical Management:
- BOS fracture with not CSF leak is managed conservatively
- If a feeding tube is required, an orogastirc tube is used instead of nasogastric tube.Nasogastric tube is not used due to the risk of increased trauma to the region
- For surgical repair, it involves a frontal lobe craniotomy with repair of the dural defect using a fascia lata graft

6) Physiotherapy Management:
- Consult neurosurgical registrar before mobilizing
- Many of these patients will have vestibular problem due to the proximity of the BOS fracture to the VIII cranial nerve.
- If patient has vertigo on ambulation, he/she may need stemetil (medication) regularly

7) Respiratory Care
- All suction should be performed via the guedels airway or via an endotracheal tube or trachyeostomy. This will avoid further trauma to the region and minimise the risk of infection