Cerebrospinal Fluid Leakage during Dacryocystorhinostomy in a Patient with Meningoencephalocele

Abstract

Dacryocystorhinostomy surgery in patients with a history of trauma or surgery or congenital defects around the base of the nose or lacrimal system may rarely result in cerebrospinal fluid leakage; thus an ophthalmologist should be familiar with its management.

Positional relationship between lacrimal sac and skull base: implication of risk of cerebrospinal fluid leakage during dacryocystorhinostomy

“…To avoid twisting and rotational forces to the rongeur, alternative use of a drill and an ultrasonic bone aspirator is useful 19 , 20 . For patients with a high risk of CSF leakage during DCR, such as pre-existing deformity and an anatomical abnormality of the skull base 5 , 6 , the use of an image-guided navigation system may be helpful to avoid this complication 21 .…”

“…Indirect injury can occur when a twisting movement of a bone rongeur is applied to the maxillary bone during the creation of a bony window, causing a spiral fracture involving the skull base 1 , 5 . The cribriform plate is a common part of injury during DCR because of its thinness and lower position 6 , and its position varies among individuals and races 8 . Surgeons should understand the details of the anatomy of the lacrimal drainage system and skull base, especially the cribriform plate, to avoid CSF leakage during DCR.…”

Cerebrospinal Fluid Leak Presenting as Epiphora

“…CSF leaks into the orbit are rarely reported in the ophthalmic literature but do occur as a complication seen after various orbital surgeries, including external 3,4 and endonasal 5,6 dacrocystorhinostomy (DCR), orbital decompression 5 , and orbital exenteration. 7 In these cases, the CSF leak presents as rhinorrhea, instead of tearing.…”

Cerebrospinal Fluid Leak as a Complication of Oculoplastic Surgery

“…During external DCR, osteotomies should be performed with sharp rongeurs without any twisting or torsional movements to prevent extension of a fracture to the skull base. 34,35 Fracture of an attenuated superior wall of an ethmoid air cell may erode into the orbital roof and cause leakage as well. 31 During endonasal DCR, other considerations include nasal septal deviation, the presence of which may require excessive tension against the septum, causing secondary leak.…”