{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,8]],"date-time":"2026-02-08T10:37:56Z","timestamp":1770547076191,"version":"3.49.0"},"reference-count":56,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[1998,3]]},"abstract":"<jats:p content-type=\"fine-print\"><jats:italic>Object.<\/jats:italic> A classification is proposed to organize anterior cranial base fractures systematically according to their location and size. The goal of this study was to determine whether these two variables, irrespective of cerebrospinal fluid (CSF) rhinorrhea, are related to the long-term risk of posttraumatic meningitis and, hence, to standardize decision making concerning surgical repair of associated CSF fistulas.<\/jats:p><jats:p content-type=\"fine-print\"><jats:italic>Methods.<\/jats:italic> With the aid of high-resolution thin-section coronal computerized tomography (CT) scanning, anterior cranial base fractures were classified into the following four major types: I, cribriform; II, frontoethmoidal; III, lateral frontal; and IV, complex (any combination of the other three types). Fractures with a maximum bone displacement that extended farther than 1 cm in any plane were classified as \u201clarge\u201d and those less than 1 cm as \u201csmall.\u201d<\/jats:p><jats:p content-type=\"fine-print\">The authors used this classification in a study of 48 patients who were treated by conservative (20 patients) or surgical (28 patients) means. The results showed a gradation of risk: the fracture most likely to develop infection was a large cribriform (Type I) and the least likely was a small lateral frontal (Type III). Statistical analysis showed that the trend for an increased infection rate was related to the cumulative effect of three variables in the following order: 1) prolonged duration of rhinorrhea (analysis of variance [ANOVA], p = 0.017); 2) large size of fracture displacement (ANOVA, p = 0.079); and 3) fracture's proximity to the midline (ANOVA, p = 0.015).<\/jats:p><jats:p content-type=\"fine-print\"><jats:italic>Conclusions.<\/jats:italic> In this series, microsurgical repair was accompanied by a minimum complication rate. Hence, the authors recommend that patients with fractures that combine the aforementioned variables should be considered to have a high long-term risk of infection and their injury should be surgically repaired as soon as the posttraumatic edema has subsided. This applies to the following fractures: large cribriform (Type I) with transient rhinorrhea lasting 5 to 8 days and large frontoethmoidal (Type II) with prolonged rhinorrhea lasting longer than 8 days. Furthermore, the authors conclude that this classification can improve the management of posttraumatic CSF fistulas of the anterior cranial base and may provide insights into the mechanisms underlying their spontaneous repair and susceptibility to meningitis.<\/jats:p>","DOI":"10.3171\/jns.1998.88.3.0471","type":"journal-article","created":{"date-parts":[[2009,6,16]],"date-time":"2009-06-16T02:25:11Z","timestamp":1245119111000},"page":"471-477","source":"Crossref","is-referenced-by-count":63,"title":["Compound anterior cranial base fractures: classification using computerized tomography scanning as a basis for selection of patients for dural repair"],"prefix":"10.3171","volume":"88","author":[{"given":"Damianos E.","family":"Sakas","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David J.","family":"Beale","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ameen A.","family":"Ameen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Helen L.","family":"Whitwell","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karl W.","family":"Whittaker","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Axel J.","family":"Krebs","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Khalid H.","family":"Abbasi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Palithe S.","family":"Dias","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"ref401","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1136\/jnnp.4.1.23","article-title":"Head injuries and meningitis.","volume":"4","author":"Linnel","year":"1941","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"ref541","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1007\/BF01400499","article-title":"Evaluation of MR imaging, digital subtraction cisternography, and CT cisternography in diagnosing CSF fistula.","volume":"111","author":"Wakhloo","year":"1991","journal-title":"Acta Neurochir"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"1818","DOI":"10.1001\/jama.1960.03020340036010","article-title":"Meningitis following trauma to the head and face.","volume":"173","author":"Appelbaum","year":"1960","journal-title":"JAMA"},{"key":"ref251","first-page":"721","article-title":"Liquorrh\u00e9e et m\u00e9ningite aigu\u00eb. Complications d'une fistule de liquide c\u00e9phalorachidien cons\u00e9cutive \u00e0 une fracture du cr\u00e2ne survenue 45 ans auparavant.","volume":"22","author":"Vlajic","year":"1976","journal-title":"Neurochirurgie"},{"key":"ref321","doi-asserted-by":"crossref","first-page":"381","DOI":"10.3109\/02688699008992759","article-title":"Acute traumatic CSF fistulae: the risk of intracranial infection.","volume":"4","author":"Eljamel","year":"1990","journal-title":"Br J Neurosurg"},{"key":"ref431","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1016\/0090-3019(91)90073-I","article-title":"Unusually late onset of cerebrospinal fluid rhinorrhea after head trauma.","volume":"35","author":"Okada","year":"1991","journal-title":"Surg Neurol"},{"key":"ref211","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1097\/00000658-195704000-00008","article-title":"Chronic and delayed traumatic cerebrospinal rhinorrhea as a source of recurrent attacks of meningitis.","volume":"145","author":"Schneider","year":"1957","journal-title":"Ann Surg"},{"key":"ref221","first-page":"92","article-title":"Sinonasal cavity: topographic imaging anatomy","volume-title":"Head and Neck Imaging","author":"Som","year":"1991"},{"key":"ref231","first-page":"2269","article-title":"Cerebrospinal fluid fistulae: their management and repair","volume-title":"Neurological Surgery.","author":"Spetzler","year":"1990"},{"key":"ref261","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1007\/BF01400499","article-title":"Evaluation of MR imaging, digital subtraction cisternography, and CT cisternography in diagnosing CSF fistula.","volume":"111","author":"Wakhloo","year":"1991","journal-title":"Acta Neurochir"},{"key":"ref271","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1159\/000120497","article-title":"Posttraumatic meningitis in adolescents and children.","volume":"16","author":"Wilson","year":"1990\/1991","journal-title":"Pediatr Neurosurg"},{"key":"ref191","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1007\/978-3-642-73061-0_5","volume-title":"Surgery of the Skull Base. 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The selection of patients for dural repair.","volume":"59","author":"Jefferson","year":"1972","journal-title":"Br J Surg"},{"key":"ref171","doi-asserted-by":"crossref","first-page":"399","DOI":"10.3171\/jns.1969.30.4.0399","article-title":"Cerebrospinal fluid fistula: clinical aspects, techniques of localization, and methods of closure.","volume":"30","author":"Ray","year":"1969","journal-title":"J Neurosurg"},{"key":"ref361","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1002\/bjs.1800590802","article-title":"Fractures of the floor of the anterior cranial fossa. The selection of patients for dural repair.","volume":"59","author":"Jefferson","year":"1972","journal-title":"Br J Surg"},{"key":"ref531","first-page":"721","article-title":"Liquorrh\u00e9e et m\u00e9ningite aigu\u00eb. 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