Executive Editor: Daniel Buchbinder General Editor: Daniel Buchbinder

Authors: S Fusetti, B Hammer, R Kellman, C Matula, EB Strong, Co-author: A Di Ieva

Skull base & Cranial vault

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Glossary

Frontal sinus fracture, anterior table

Please select a treatment option:
Treatment Main indication Skill Equipment
Observation Minimally displaced anterior table fractures (< 1-2 mm) not involving the nasofrontal recess injury. Basic surgical experience, no specialized skills Basic equipment only
Open reduction internal fixation Fractures with greater displacement (> 2 mm) NOT INVOLVING the nasofrontal recess. Some specialized surgical experience Simple surgical and imaging resources
Obliteration Anterior table fractures which include the sinus floor resulting in nasofrontal recess injury. Some specialized surgical experience Simple surgical and imaging resources
Delayed endoscopic repair Isolated fractures of the anterior table with residual cosmetic deformity, without demonstrable obstructive sinus pathology. Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Frontal sinus fracture, frontal recess

Please select a treatment option:
Treatment Main indication Skill Equipment
Obliteration Any frontal sinus fracture resulting in nasofrontal recess injury. Highly experienced and skilled surgeon Simple surgical and imaging resources
Observation (and when indicated frontal sinus endoscopy) Anterior table fractures involving the sinus floor with questionable nasofrontal recess injury. Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Frontal sinus fracture, posterior table

Please select a treatment option:
Treatment Main indication Skill Equipment
Observation Minimally displaced posterior table fractures, without evidence of nasofrontal recess injury, and minor CSF leak. Basic surgical experience, no specialized skills Basic equipment only
Cranialization Displaced posterior table fractures, with or without evidence of nasofrontal recess injury, with or without CSF leak. Highly experienced and skilled surgeon Simple surgical and imaging resources
Obliteration Displaced posterior table fractures, without comminution, and without CSF leak. Highly experienced and skilled surgeon Simple surgical and imaging resources

Skull base fracture, anterior

Please select a treatment option:
Treatment Main indication Skill Equipment
Observation Non- or minimally displaced fractures without CNS injury and stable neurological status. Basic surgical experience, no specialized skills Basic equipment only
Intradural repair Displaced fractures with evidence of CNS injuries. Highly experienced and skilled surgeon Simple surgical and imaging resources
Extradural repair Displaced fractures with evidence of CNS injuries or CSF leak that does not resolve spontaneously. Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Skull base fracture, central (anterior)

Please select a treatment option:
Treatment Main indication Skill Equipment
Observation Non- or minimally displaced fractures without CNS injury and stable neurological status. Basic surgical experience, no specialized skills Basic equipment only
Endoscopic repair of CSF leak Central anterior skull base fractures resulting in CSF rhinorrhea. Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Skull base fracture, posterior

Please select a treatment option:
Treatment Main indication Skill Equipment
Observation Non- or minimally displaced fractures. Basic surgical experience, no specialized skills Basic equipment only
Treatment modalities Depressed fractures with a significant intracranial injury. Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Skull base fracture, lateral

Please select a treatment option:
Treatment Main indication Skill Equipment
Observation Non- or minimally displaced fractures. Basic surgical experience, no specialized skills Basic equipment only
Extradural middle fossa repair using temporal fascia flap Displaced fractures with evidence of CNS injuries. Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Skull base fracture, temporal bone (lateral skull base)

Please select a treatment option:
Treatment Main indication Skill Equipment
Observation Non- or minimally displaced fractures without CNS or vascular injury, and stable neurological status. Basic surgical experience, no specialized skills Basic equipment only
Surgical management Displaced fractures with evidence of CNS/vascular injuries. Highly experienced and skilled surgeon Simple surgical and imaging resources
Delayed management of hearing loss Persistent conductive hearing loss suggesting damage to the middle ear. Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Cranial vault fracture

Please select a treatment option:
Treatment Main indication Skill Equipment
Observation Non- or minimally displaced fractures not involving the frontal sinus, without CNS or vascular injury, and stable neurological status. Basic surgical experience, no specialized skills Basic equipment only
Treatment of depressed cranial vault fractures Depressed fractures (decompression of the brain requires acute treatment). Some specialized surgical experience Simple surgical and imaging resources

Special considerations

Traumatic brain injury/Vascular injury
Infections
Late sequelae
Cranioplasty (bone versus alloplast)
*Skill
Basic surgical experience, no specialized skills Basic surgical experience, no specialized skills
Some specialized surgical experience Some specialized surgical experience
Highly experienced and skilled surgeon Highly experienced and skilled surgeon
*Equipment
Basic equipment only Basic equipment only
Simple surgical and imaging resources Simple surgical and imaging resources
Full specialized surgical and imaging resources Full specialized surgical and imaging resources

v1.0 2011-05-14