Persistent Post-Traumatic Orbital Cerebrospinal Fluid Fistula with Multiple Episodes of Meningitis: Systematic Case Review and Case Report

Authors

  • Glaucia Suzanna Jong A Liem Faculty of Medicine, Universidade do Estado do Pará, Belém, PA, Brazil
  • Carlos dos Reis Lisboa-Neto Division of Neurosurgery, Hospital Ophir Loyola, Belém, PA, Brazil
  • Fernando Mendes Paschoal Junior Division of Neurology and Neurosurgery, Hospital Universitário João de Barros Barreto da Universidade Federal do Pará, Belém, PA, Brazil
  • Ana Carolina Maués de Oliveira Faculty of Medicine, Universidade do Estado do Pará, Belém, PA, Brazil
  • Edson Bor-Seng-Shu Division of Neurosurgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
  • Manoel Jacobsen Teixeira Division of Neurosurgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
  • Eric Homero Albuquerque Paschoal Division of Neurosurgery, Hospital Ophir Loyola, Belém, PA, Brazil

DOI:

https://doi.org/10.3823/2050

Keywords:

CSF fistula, CSF leak, TBI, complications, meningitis, adolescent, oculorrhea

Abstract

Title: Persistent post-traumatic orbital cerebrospinal fluid fistula with multiple episodes of meningitis: a systematic review and case report

Background: Orbital cerebrospinal fluid (CSF) fistulas are very rare. Most of these fistulas spontaneously heal within a couple of days and usually do not require surgical repair. Furthermore, they present low rates of complications. Case presentation: We report a case of a 15-year-old boy that suffered a penetrating head trauma and developed multiple episodes of meningitis due to a persistent orbital and nasal CSF fistula. He underwent multiple different procedures to correct the dural breach: sphenoidal endoscopic approach, and three craniotomies, the last one succeeded with the placement of autologous grafts and biological glue. A lombar-subarachnoidal peritoneal shunt was placed to aid for 5 days. The CSF fistula ceased to drain and he recovered of the meningitis with additional standard antibiotics. Review: A systematic review in MedLine, Embase and Lilacs, identified 15 reported cases of persistent orbital CSF fistulas post-trauma. Traffic accidents were the most common mechanism of trauma. Most cases were in young boys and the main clinical manifestation was persistent “oculorrheaâ€. The CSF leaks were traced with CT-scans and were predominantly managed surgically. No fatal outcomes were reported. Conclusion: The reported cases raise awareness for persistent orbital CSF fistulas. Early diagnosis and adequate management is crucial to prevent complications, which are rare, but can be highly morbid and fatal.

Author Biography

Eric Homero Albuquerque Paschoal, Division of Neurosurgery, Hospital Ophir Loyola, Belém, PA, Brazil

Vascular neurosurgeon and neuroradiology interventionist

 

References

Apkarian AO, Hervey-Jumper SL, Trobe JD (2014) Cerebrospinal fluid leak presenting as oculorrhea after blunt orbitocranial trauma. J Neuroophthalmol 34:271-273

Arslantas A, Vural M, Atasoy MA, Ozsandik A, Topbas S, Tel E (2003) Posttraumatic cerebrospinal fluid accumulation within the eyelid: a case report and review of the literature. Childs Nerv Syst 19:54-56

Bagolini B (1957) Leakage of spinal fluid into upper eyelid following trauma. Arch Ophtalmol 57:454-456

Bhatoe HS (2002) Blepharocele after head injury. Skull base 12:73-76

Borumandi F (2013) Traumatic orbital CSF leak. BMJ Case Rep DOI:10.1136/bcr-2013-202216

Brodie HA (1997) Prophylactic antibiotics for posttraumatic cerebrospinal fluid fistulae. A meta-analysis. Arch Otolaryngol Head Neck Surg 123:749-752

Chandra N, Ojha BK, Chandwani V, Srivastava C, Singh SK, Chandra A (2013) A rare case of posttraumatic eyelid swelling: cerebrospinal fluid blepharocele. J Neurosurg Ped 11:242-244

Civelek E, Bilgic S, Kabatas S, Hepgul KT (2006) Penetrating transorbital intracranial foreign body. Ulus Travma Acil Cerrahi Derg 12:245-248

David CA, Catalano PJ (2002) Commentary to article "Blepharocele after head injury" by Bhatoe, H. S. Skull base 12:76

Dryden RM, Wulc AE (1986) Pseudoepiphora from cerebrospinal fluid leak: case report. Br J Ophthalmol 70:570-574

Friedman JA, Ebersold MJ, Quast LM (2000) Persistent posttraumatic cerebrospinal fluid leakage. Neurosurg Focus 9:e1

Garza-Mercado R, Aragon-Lomas J, Martinez-Garza J, Leal-Hernandez L (1982) Cerebrospinal fluid blepharocele: an unusual complication of head injuries. Neurosurgery 11:525-526

Joshi KK, Crockard HA (1978) Traumatic cerebrospinal fluid fistula simulating tears. Case report. J Neurosurg 49:121-123. doi:10.3171/jns.1978.49.1.0121

Kawamura S, Hadeishi H, Sasaguchi N, Suzuki A, Yasui N (1997) Penetrating head injury caused by chopstick--case report. Neurol Med Chir 37:332-335

Mandrioli S, Tieghi R, Galie M, Denes SA, Pagliaro F, Clauser L (2008) Anterior skull base fractures: guidelines for treatment. J Craniofac Surg 19:713-717

Pease M, Marquez Y, Tuchman A, Markarian A, Zada G (2013) Diagnosis and surgical management of traumatic cerebrospinal fluid oculorrhea: case report and systematic review of the literature. J Neurol Surg Rep 74:57-66

Pereira FJ, Bettega ABP, Cruz AVV (2011) Fístula liquórica traumática com luxação de globo ocular: relato de caso. Arq Brasileiros Oftalmol 74:58-60

Salame K, Segev Y, Fliss DM, Ouaknine GE (2000) Diagnosis and management of posttraumatic oculorrhea. Neurosurg Focus 9:e3

Schreckinger M, Orringer D, Thompson BG, La Marca F, Sagher O (2011) Transorbital penetrating injury: case series, review of the literature, and proposed management algorithm. J Neurosurg 114:53-61

Sibony PA, Anand AK, Keuskamp PA, Zippen AG (1985) Posttraumatic cerebrospinal fluid cyst of the orbit. Case report. J Neurosurg 62:922-924. doi:10.3171/jns.1985.62.6.0922

Terao H, Sato S (1975) Ventriculo-orbital fistula in closed head injury. Case report. J Neurosurg 43:754-756. doi:10.3171/jns.1975.43.6.0754

Till JS, Marion JR (1987) Cerebrospinal fluid masqueradin as tears. South Med J 80:639-640

Twaij S, Viswanathan P, Page AB (2009) Acute traumatic orbital cerebrospinal fluid cystocele mimicking orbital abscess. J AAPOS 13:491-493

Downloads

Published

2016-08-30

Issue

Section

Neurosurgery