Title:
Anterior Cranial Fossa Fractures: CSF Leak, Meningitis and Management in 114 Patients at Bouaké University Hospital

Authors:
Faozo Stéphane Landry Teti, Yao Bernard Fionko, Konan Serge Yao, Adama Kouadio, Adama Simaga, & Aderehime Haidara, Cote d'Ivoire

Abstract:

Background. Anterior cranial fossa fractures (ACFF) open a direct route between the paranasal sinuses and the subarachnoid space, exposing patients to cerebrospinal fluid (CSF) leak and meningitis. Data from sub-Saharan Africa, where motorcycle crashes dominate, are scarce.

Objective. To describe ACFF and their leak-related complications (CSF fistula, meningitis) in a West African neurosurgical cohort, and to explore the lesional factors associated with them.

Methods. Single-centre observational study (STROBE) drawn from the institutional head-injury database of Bouaké University Hospital (1,366 patients). We analysed the 114 patients of the recent series (2025–2026), in whom complications were recorded in a standardised way. The primary outcome was a CSF fistula and/or meningitis. Groups were compared with Fisher's exact and Mann–Whitney tests, and crude and Firth odds ratios (OR) are reported. With 10 events, no conventional multivariable model was fitted; one two-variable Firth model is shown for illustration only. Missing values were not imputed.

Results. Patients were young men (mean age 29.7 years; 93.9% male) injured in road-traffic crashes (92.1%), mostly on motorcycles. Median Glasgow Coma Scale score was 13 (mild injury in 63.2%). The most frequent associated lesions were contusion (62.3%), facial fracture (43.0%) and an evident osteodural breach (28.1%). Ten patients (8.8%) had a leak-related complication: 8 CSF fistulas (7.0%) and 2 cases of meningitis (1.8%). No association was significant. Pneumocephalus (Firth OR 4.2; 95% CI 0.97–18.1; Fisher p = 0.087) and an evident osteodural breach (OR 2.8; 95% CI 0.79–10.1; p = 0.140) were more frequent in patients with a complication, and both meningitis cases had a depressed fracture. Skull-base repair was documented in 66.7% of patients, antibiotics were given to 88.6% and vaccination against encapsulated bacteria to 63.2%. Outcome was documented in 108 patients (94.7%); all 10 complications had a favourable outcome, and the 3 in-hospital deaths (2.6%) were not attributed to fistula or meningitis.

Conclusion. CSF fistula and meningitis were uncommon (8.8%) and had a favourable course. Management was broad and uncompared, so the effect of any of its components cannot be judged. Pneumocephalus and an evident osteodural breach remain hypotheses for larger multicentre studies.

DOI: http://dx.doi.org/10.51505/ijmshr.2026.10512