Management of skull base fractures in Cameroon: a multi-institutional cross-sectional study

Abstract

Abstract Introduction This cross-sectional study aimed to evaluate the epidemiological, clinical, radiological, and therapeutic aspects of skull base fractures (SBF) in Yaoundé, Cameroon. Methods Patient records from three reference hospitals were reviewed retrospectively for SBF patients admitted between July 2010 and June 2017. Patients with missing data were excluded from the analysis, summary descriptive and unadjusted analyses were conducted. Results Of 867 retrievable head injury charts, 338 (39%) met inclusion criteria. Mean age was 31.2 ± 13.4 years and 86% of participants were male. Road traffic accidents accounted for 84.4% of cases, with motorcycles implicated in 64%. Fractures involved the anterior cranial fossa in 60.1%, middle fossa in 32.5%, combined anterior–middle in 4.4%, and posterior fossa in 2.4%. CT explained clinical signs in 88.3% overall, CSF rhinorrhea had the highest odds of radiological confirmation compared with other anterior signs (OR 6.71; 95% CI, 1.59–28.32) and mastoid ecchymosis showed strong agreement in the middle fossa (OR 5.47; 95% CI, 0.72–41.56). Translabyrinthine temporal bone fractures were strongly associated with cranial nerve VII palsy (OR 4.07; 95% CI, 1.75–9.47) and vestibular symptoms (i.e., vertigo OR 3.30; 95% CI, 1.24–8.80 and tinnitus OR 3.72; 95% CI, 1.05–13.21). Management was conservative in 65.1% and surgical in 34.9%, mainly for persistent CSF leaks. Postoperative complications were rare, but olfactory deficits persisted in 78% of operated cases. Conclusion SBF is common in Cameroon, and its management is made difficult by a lack of resources. Investments in the surgical system must be made to improve patient outcomes.