Cerebrospinal Fluid Leaks in Orbital and Lacrimal Surgery

An Anatomical Study of the Positional Relationship Between the Ethmoidal Foramina and the Frontoethmoidal Suture

“…9 Bone removal above the level of the frontoethmoidal suture occasionally causes cerebrospinal fluid leakage. [12][13][14] However, the frontoethmoidal suture is sometimes unclear, and it is necessary then to confirm the suture under the guidance of the ethmoidal foramina. As the ethmoidal foramina are occasionally located above the frontoethmoidal suture, watchful procedure is needed in such a situation.…”

Early Experience Using a New Modified Bone Nibbler for Superior Osteotomy During Endonasal Dacryocystorhinostomy

“…The risk of cerebrospinal fluid leak during DCR surgery is, however, low. Limawararut et al 20 found no cases of cerebrospinal fluid leak in their series of 3,504 patients, the majority of whom underwent external DCR, where superior osteotomy would routinely be carried out using bone punches or nibblers. The ceiling beam lies in close proximity to the ethmoid air cells, the fovea ethmoidalis, and the cribriform plate.…”

Cerebrospinal Fluid Leak as a Complication of Oculoplastic Surgery

“…The largest single review was by Limawararut et al, who compiled data from four institutions. 10 In total, five leaks occurred from a total of 4,055 surgeries. This was subclassified by procedure as 1/154 (0.6%) with orbital exenteration, 4/397 (1%) with orbital decompression, and 0/3504 (0%) with dacryocystorhinostomy.…”

“…Reports of leaks following exenteration are limited to 21 cases in eight publications. 10,[16][17][18][19][20][21][22] There are several important details to note regarding these cases. Of the 12 cases with details on the timing of leak, 10 occurred intraoperatively, one occurred on post-operative day one, and one was detected four years after surgery.…”

“…28 Some surgeons advocate using a diamond burr rather than a cutting burr to slow the rate of bone removal and decrease the risk of damage to the dura. 10 In medial orbital decompression, a low-lying fovea ethmoidalis may predispose to inadvertent violation of the cribriform plate. Similar to the lateral orbit, CT scan evaluation pre-and intraoperatively may decrease the risk of this.…”