June 2013
Volume 54, Issue 15
ARVO Annual Meeting Abstract  |   June 2013
Orbital Cerebrospinal Fluid Leak Following Pterional Orbitozygomatic Craniotomy
Author Affiliations & Notes
  • zakeya alsadah
    oculoplastics, kkesh, riyadh, Saudi Arabia
  • Michael Yoon
    Massachusetts Eye and Ear Infirmary, boston, MA
  • Timothy McCulley
    oculoplastics, kkesh, riyadh, Saudi Arabia
    oculoplastics, Wilmer Eye Institute, Johns Hopkins, baltimore, MD
  • Footnotes
    Commercial Relationships zakeya alsadah, None; Michael Yoon, None; Timothy McCulley, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science June 2013, Vol.54, 5344. doi:
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      zakeya alsadah, Michael Yoon, Timothy McCulley; Orbital Cerebrospinal Fluid Leak Following Pterional Orbitozygomatic Craniotomy. Invest. Ophthalmol. Vis. Sci. 2013;54(15):5344.

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      © ARVO (1962-2015); The Authors (2016-present)

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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.

Keywords: 631 orbit  

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