TRAUMATIC CSF FISTULAS (RHINORRHEA/OTORRHEA) (A RETROSPECTIVE STUDY OF 52 CASES)

Cerebro-spinal fluid (CSF) fistula is leakage of fluid from sub-arachnoidal to extra-arachnoidal spaces when there is a defect of arachnoidea, dura, bone or epithelial tissues. This leakage can be through all the cerebrospinal axis but generally seen as rhinorrhea or otorrhea. The etiology of CSF fistulas in 80 of cases is trauma. It can be seen in 2-5% of closed head injuries. It may be detected either in the posttraumatic first week or within months and years after trauma as well. 85% of rhinorrheas and nearly all of otorrheas interrupt spontaneously at the end of one week. Meningitis is the most important complication of CSF fistulas. 52 cases of traumatic CSF fistula which were treated in our department between January 1990-June 1995 were reviewed retrospectively. Age distribution of the patients were 2-70 years and male/female ratio was 3/1. The most frequent etiological factors were traffic accidents and falling traumas. 79% of patients treated conservatively and even though were under control of antibiotic therapy meningitis in 11 cases and cerebral abscess in 1 case were revealed. Mortality rate of meningitis was 33.3% in our series. In this study, we saw that there was no any effect of prophylactic antibiotic treatment to meningitis rates and Klebsiella was the most frequent organism in microbiological investigations of patients with meningitis.

TRAVMATÝK BOS FÝSTÜLLERÝ (RÝNORE/OTORE) (52 OLGUNUN RETROSPEKTÝF DEÐERLENDÝRÝLMESÝ)

Beyin omurilik sývýsý (BOS) fistülü, BOS'nýn araknoid, dura, kemik veya epitel dokuda defekt olduðu zaman subaraknoid mesafeden ekstra araknoid mesafeye kaçýþýdýr. Serebrospinal aks boyunca herhangi bir yerden olabilir, ancak sýklýkla rinore veya otore þeklinde görülür. BOS fistüllerinin %80'inin nedeni travmadýr. Kapalý kafa travmalarýnýn %2-5'inde görülür. Travmanýn ilk haftasýnda akut olarak baþlayacaðý gibi bazen, aylar veya yýllar sonrada gecikmiþ olarak baþlayabilir. Rinorelerin %85'i, otorelerin ise tamama yakýný bir hafta içinde kendiliðinden kesilir. BOS fistüllerinin en önemli komplikasyonu menenjittir. Kliniðimizde Ocak 1995 yýllarý arasýnda tedavi edilen 52 travmatik BOS fistülü olgusu retrospektif olarak deðerlendirilmiþtir. Hastalar 2-70 yaþ aralýðýnda olup, erkekler de üç kat fazla görülmüþtür. Trafik kazasý ve düþme en sýk travmatik nedenlerdir. Olgularýn %79'u konservatif tedaviye yanýt vermiþtir. Hastalarýn hepsine profilaktik antibiyotik verilmesine raðmen 11 hastada menenjit, 1 hastada abse görülmüþtür. Menenjite baðlý mortalite oraný %33.3'tür. Bu çalýþmadan profilaktik antibiyotik kullanýlmasýnýn menenjit oranýný deðiþtirmediði, negatif kültür oranýný ve özellikle Klebsiella menenjitinin yüksek oranda görülmesine neden olduðu sonucu çýkarýlmýþtýr.