Clinical significance of long-term follow-up of children with posttraumatic skull base fracture

Abstract Background To assess in children with skull base fractures, incidences of cerebrospinal fluid (CSF) leak, meningitis, and the need for prophylactic antibiotics, anti-pneumococcal vaccination, and surgical interventions. Methods We reviewed the records of children with skull base fractures who were admitted to our tertiary care center during 2009-2014. Results 196 children (153 male) were hospitalized with skull base fractures, aged 1 month to 18 years (mean 6 ± 4 years). Causes of injury were falls (143), motor vehicle accidents (34), and other (19). Fracture locations were: middle skull base (112), frontal base (62), and occipital base (13). Fifty-four (28%) children had a CSF leak. For 34 of them (63%), spontaneous resolution occurred within 3 days. Three children were operated at admission due to a CSF leak from an open wound, 3 underwent CSF diversion by spinal drainage, and 4 (2%) required surgery to repair a dural tear after failure of continuous spinal drainage and acetazolamide treatment. Twenty-eight (14%) received prophylactic antibiotics, usually due to other injuries, while 11 received pneumococcal vaccination. Two children developed meningitis and three died. Long-term follow up in 124 children revealed 12 with delayed hearing loss and 3 with delayed facial paralysis. Conclusion This is the largest pediatric series of skull base fractures reporting rates of morbidity and long term outcomes. The rate of meningitis following skull base fracture in children is low, supporting a policy of not administering prophylactic antibiotics or pneumococcal vaccine. Long-term follow up is important to identify delayed complications.