Diagnosis and Surgical Management of Traumatic Cerebrospinal Fluid Oculorrhea: Case Report and Systematic Review of the Literature

Abstract

Background Oculorrhea, or cerebrospinal fluid leakage developing from a cranio-orbital fistula, is a rare development following traumatic injury.Case Report A 22-year-old man involved in a motor vehicle accident developed a blowout fracture of the left orbital roof penetrating the frontal lobe, inducing oculorrhea. He underwent a supraorbital craniotomy for removal of the bony fragment and skull base reconstruction using a pericranial flap.Methods A systematic review of the database was performed to identify all prior cases of traumatic oculorrhea.Results Twenty-two reported cases met inclusion criteria for subsequent analysis. Oculorrhea developed due to blunt and penetrating head injury in 14 (64%) and 8 patients (36%), respectively. The most common mechanisms were car accidents, stab wounds, falls, and gunshot wounds. Ocular signs and symptoms—including visual loss, ophthalmoplegia, and pupillary dysfunction—were commonly associated findings. Initial conservative management was successful in four patients. Thirteen patients underwent initial surgical intervention, and three additional patients required operative intervention following failed conservative treatment.Conclusion Although oculorrhea rarely develops following severe orbital trauma, suspicion should nevertheless be maintained to facilitate more prompt diagnosis and management. The decision for conservative versus surgical management often depends on the severity of the fracture and dural injury.

Traumatic orbital CSF leak

“…CSF leak was first described by Galen as a periodic release of fluid into the nose via the sella and ethmoid regions 1 2. The middle and anterior cranial fossa are well-known sites, where a CSF fistula (otorrhea/rhinorrhea) can develop following head trauma 1.…”

“…The middle and anterior cranial fossa are well-known sites, where a CSF fistula (otorrhea/rhinorrhea) can develop following head trauma 1. Compared to the above, the traumatic orbital CSF leak is a rare and under-reported condition 1–4.…”

“…Thus, the orbital CSF leak may frequently remain undiagnosed. According to a recent systematic review, just 22 cases of traumatic orbital CSF leak have been reported in the English literature 1. However, recognition of CSF leak is important to avoid persistent CSF leakage, meningitis and abscess formation 1–6.…”

“…However, recognition of CSF leak is important to avoid persistent CSF leakage, meningitis and abscess formation 1–6. The external CSF leakage from the orbit can cause intracranial hypotension 1. Furthermore, late meningitis 3 years after trauma and personality changes have been reported as a consequence of orbital CSF leak 1.…”

“…The external CSF leakage from the orbit can cause intracranial hypotension 1. Furthermore, late meningitis 3 years after trauma and personality changes have been reported as a consequence of orbital CSF leak 1. In the majority of cases, the onset of orbital CSF leakage is reported to be within the first 48 h following trauma, and delayed onset reportedly occurred 5–14 days after orbital injury 1 5.…”