Orbital cerebrospinal fluid accumulation after complicated pterional-orbitozygomatic craniotomy.
We describe 2 patients who developed postoperative orbital cerebrospinal fluid (CSF) collection after orbitozygomatic pterional craniotomy. An 18-year-old woman underwent exploratory pterional-orbitozygomatic craniotomy. Five days postoperatively, after removal of a lumbar drain, proptosis and a compressive optic neuropathy developed. Computed tomography demonstrated a CSF collection contiguous with the craniotomy site. Resolution followed percutaneous aspiration and replacement of the lumbar drain. A 57-year-old woman underwent a pterional-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. Based on these cases, the mechanism seems to be the combination of iatrogenic formation of a communication with the subarachnoid space and elevated intracranial pressure. Resolution was achieved by normalizing intracranial pressure.
Department of Ophthalmology (MKY), Harvard Medical School, Boston, Massachusetts; Ophthalmic Plastic Surgery, Massachusetts Eye and Ear Infirmary (MKY), Boston, Massachusetts; Wilmer Eye Institute (WJP, TJM), Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Ophthalmology (JPR), University of Pennsylvania, Philadelphia, Pennsylvania; and Department of Neurological Surgery (MWM), University of California, San Francisco, California.
Michael K
MK
Yoon
Wachirapon Jordan
WJ
Piluek
Jason P
JP
Ruggiero
Michael W
MW
McDermott
Timothy J
TJ
McCulley
D000293:Adolescent; D003399:Craniotomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008577:Meningeal Neoplasms; D008579:Meningioma / Q000601:surgery; D008875:Middle Aged; D009915:Orbit / Q000601:surgery*; D011183:Postoperative Complications / Q000134:cerebrospinal fluid*; D015898:Tomography Scanners, X-Ray Computed; D014792:Visual Acuity