Acute traumatic orbital encephalocele: A case report with review of literature

Abstract

Orbital roof fractures after a blunt injury are an uncommon complication of trauma. Traumatic encephaloceles in the orbital cavity are even rarer, with only 15 cases published till date. Raised intraorbital pressure leading to irreversible damage to the optic nerve can be prevented by early diagnosis and management. Orbital computed tomography (CT) with thin axial and coronal sections is helpful in trauma patients with a concurrent orbital trauma. Decompression of the orbital roof is the key step in surgical treatment and should be performed in every case. Repairing the orbital roof has to be performed to avoid transmission of variation in the intracranial pressure to the orbit. We present a case of traumatic orbital encephalocele who underwent surgical treatment via a frontobasal approach with evacuation of the contused herniated brain and reconstruction of the orbital roof using temporalis fascia which is readily available in contrast to costly materials like titanium mesh, screws, bone powder, fibrin glue, and so on, which are not easily available in every hospital. Rapid resolution of proptosis and visual symptoms along with excellent cosmetic outcome was seen at follow-ups after three and nine months. We emphasize the early diagnosis of this rare condition and also emergency treatment to prevent permanent visual loss as well as to achieve good cosmetic results.

Post-Traumatic Fronto-Ethmoidal and Orbital Encephalocele – A Rare Entity

“…The main complication of orbital encephalocele is optic nerve compression either directly or due to raised intraorbital pressure causing secondary congestion of draining veins including retinal vein leading to its atrophy & subsequent blindness [4,6]. Hence, our index case is unique as it reveals a combination of fronto-ethmoidal and orbital encephalocele requiring team-effort and a dedicated neuroophthalmological team consisting of ophthalmic & neurosurgeon for best outcome.…”

“…Following the evacuation of herniated brain through frontobasal approach, the defect can be closed either by temporalis fascia which is natural & cheaper or by artificial material that are expensive like titanium mesh, bone powder, fibrin glue, etc. [4]. …”

“…When it extends in to the eyelid or orbit, it is known as blepharocele or orbital encephalocele respectively. Orbital encephalocele is a very rare entity that presents with proptosis, restricted movement of eye or diminished vision with less than 30 cases reported till date [4,5].…”

Late Surgical Management Of A Rare Case Of Post-traumatic Orbital Encephalocele

“…1 Orbital roof fractures secondary to blunt trauma are also rarely encountered. 2,3 Till 2013, only 15 cases of traumatic encephaloceles had been reported 4 . A large portion of the fl oor of the anterior fossa needs to be fractured, the fragments shattered and the dura torn so that the weight of the brain cannot be supported.…”

“…Complete neurological and ophthalmological examinations are necessary to rule out orbital encephalocele as ecchymosis and swollen eyelids with decreased consciousness level can delay the diagnosis. 4…”