[Special aspects in diagnosis and treatment of open craniocerebral injuries including basilar skull fractures].

The possibility of CSF leakage means that open head injuries and skull base fractures are serious and sometimes dangerous. An operation should be considered in cases of open depressed skull fractures with or without space-occupying haematoma, compound fractures of the rhinobasis and orbita, dislocated fractures of the dorsal wall of the frontal sinus, CSF leakage for longer than 1 week, and posttraumatic intracranial infection. Operative and posttraumatic intracranial infection is also potentially dangerous. The operative approach depends on the type and localization of the fracture. The transsphenoidal and frontoorbital approaches are less traumatic, but offer only limited visibility. The transfrontal intradural approach offers by far the best view of the frontobasis and is therefore indicated in most cases.