To investigate the effects of skull base exploration and reconstruction on cerebrospinal fluid leakage and tracranial infection in patients with acute traumatic brain injury (TBI) complicated with anterior skull base comminuted fracture.

The clinical data of 37 patients with acute TBI with anterior skull base comminuted fracture were analyzed retrospectively from January 2013 to March 2019. Patients were divided into two groups based on if they accepted skull base exploration and reconstruction on the first stage, i.e., the test group (skull base exploration and reconstruction) and the control group (non-skull base exploration and reconstruction), and 18 cases in the test group, 19 cases in the control group. The test group underwent craniocerebral debridement and/or intracranial hematoma removal+skull base exploration+skull base reconstruction within 24 h after injury. The flap design, craniocerebral debridement and intracranial hematoma removal in the control group were the same as those in the test group, but skull base exploration and skull base reconstruction were not performed. The incidence of postoperative cerebrospinal fluid leakage, intracranial pneumatosis and intracranial infection were compared between the two groups.

There were 1 case of cerebrospinal fluid leakage accompanied by intracranial infection in the test group, and the incidence of complication rate was 5.6%. Twelve cases of cerebrospinal fluid leakage and/or intracranial pneumatosis in the control group, including 4 cases of cerebrospinal fluid leakage, 1 case of intracranial pneumatosis, 3 cases of cerebrospinal fluid leakage and intracranial pneumatosis, 3 cases of cerebrospinal fluid leakage and intracranial infection, 1 case of cerebrospinal fluid leakage accompanied by intracranial pneumatosis and intracranial infection, and the incidence of complication was 63.2%. The difference of incidence of complication between the two groups was statistically significant (P<0.05). After skull base reconstruction, 13 patients with cerebrospinal fluid leakage and/or intracranial pneumatosis (including 1 case of cerebrospinal fluid leakage in the first stage of the test group and 12 patients in the control group) were cured, patients with intracranial infection were controlled before the second stage operation.

For patients with acute TBI complicated with anterior skull base comminuted fracture, skull base exploration and reconstruction in acute craniotomy can effectively prevent cerebrospinal fluid leakage, intracranial pneumatosis and intracranial infection.