Abstract
Purpose:
In this report we describe orbital cerebrospinal fluid (CSF) collections as a complication of orbitozygomatic pterional craniotomy. Pathophysiology and management are assessed.
Methods:
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.
Results:
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.
Conclusions:
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.