Purchase this article with an account.
zakeya alsadah, Michael Yoon, Timothy McCulley; Orbital Cerebrospinal Fluid Leak Following Pterional Orbitozygomatic Craniotomy. Invest. Ophthalmol. Vis. Sci. 2013;54(15):5344.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
In this report we describe orbital cerebrospinal fluid (CSF) collections as a complication of orbitozygomatic pterional craniotomy. Pathophysiology and management are assessed.
In this retrospective interventional case series the medical records were reviewed of two patients (18 year-old male, 57 year old female) with orbital CSF leaks following orbitozygomatic pterional craniotomy. Main measures were mechanism and management.
Case 1: An 18 year-old woman underwent exploratory orbitozygomatic pterional craniotomy. On post-operative day five, following removal of a lumbar drain, proptosis and a compressive optic neuropathy developed. Computed tomography (CT) demonstrated a CSF collection contiguous with the craniotomy site. Resolution followed percutaneous aspiration and replacement of the lumbar drain. Case 2. A 57 year-old woman underwent an orbitozygomatic craniotomy for removal of a left anterior clinoid meningioma, complicated by a large left hemorrhagic stroke requiring decompressive hemicraniectomy. Extracranial CSF collections accumulated in both the orbit and subgaleal spaces. Resolution followed placement of an external ventricular drain.
We describe orbital CSF collections as a complication of pterional-orbitozygomatic craniotomy. Based these cases the mechanism appears to be the combination of an iatrogenic communication with the sub-arachnoid space and elevated ICP. Successful management is achieved simply by normalizing ICP. In vision threatening cases, more rapid resolution is facilitated by conjunctional percutaneous drainage.
This PDF is available to Subscribers Only