Intraocular silicone oil brain migration associated with severe subacute headaches: a case report

Abstract

Purpose The aim of this article is to report a rare case in which a patient presented symptomatic silicon oil brain migration, documented by MRI, several years after vitreoretinal surgery. Methods This is a case report with a prospective literature review. Patients The patient described in the case report. Results Case report. Discussion/conclusions For several years, silicone oil (SiO) has been widely used as a long-term intravitreal tamponading agent to treat complex retinal detachments. There are rare reports in the literature demonstrating the migration of SiO into the brain. The aim of this article is to report a rare case in which the patient presented severe headaches several years after vitreoretinal surgery, with migrated SiO appearing in MRI as an oval lesion within the horn of the right lateral ventricle. To the best of our knowledge, there are very few reports of symptomatic SiO brain migration in the literature.

Ventricular Migration of Vitreous Silicone Oil Masquerading as a Ruptured Colloid Cyst

“…As ventricular SiO migration is asymptomatic in the vast majority of cases, no treatment is required. In the uncommon scenario that treatment is required, Mazzeo et [5,6].…”

“…The literature most often describes this radiographic finding as incidental, and many patients are asymptomatic [4]. Symptoms are rare but include chronic headaches due to elevated intracranial pressure [5,6]. Due to the incidental nature of the findings, the time interval between SiO injection and intraventricular SiO migration is unclear, with time intervals ranging from 6.5 months to as long as 25 years [4].…”

“…On computed tomography (CT), the SiO appears as a mass-like focus of hyperdensity in the cerebral ventricles, while on magnetic resonance imaging (MRI), the focus is hyperintense to cerebrospinal fluid on pre-contrast T1-weighted images and hypointense on T2-weighted images [7]. Management of symptomatic SiO migration includes conservative medical management for pain relief and, if necessary, shunting to relieve elevated intracranial pressure [5,6].…”

Silicone oil emulsification: A literature review and role of widefield imaging and ultra-widefield imaging with navigated central and peripheral optical coherence tomography technology

“…[ 9 19 48 ] Migration of emulsified SO is a significant concern, as these droplets have been detected in different extraocular locations, including the orbit, optic chiasm, and brain. [ 49 50 51 ] Intraocularly, SO is known to migrate to sclera and conjunctiva, forming cysts of emulsified SO accompanied by inflammatory infiltration over a period of approximately 4 months. [ 52 ] New imaging techniques such as anterior segment (AS)-OCT, UWF, and navigated SS-OCT may provide a better characterization of these adverse events, especially in the anterior chamber (AC) angle and the peripheral retina.…”

Vitreous Substitutes from Bench to the Operating Room in a Translational Approach: Review and Future Endeavors in Vitreoretinal Surgery

“…PDMS’s quality and purification is crucial for obtaining a stable and non-toxic SiO for use in vitreoretinal surgery, and it is today known that SiOs can have a low long-term toxic effect on the eye tissues, and even to the tissues surrounding the eye globe. Finding a solution to that is still an ongoing topic of research [ 62 , 91 , 92 , 93 ].…”