Intraorbital Encephalocele: An Important Complication of Orbital Roof Fractures in Pediatric Patients

Abstract

Orbital roof fractures are uncommon, and traumatic intraorbital encephalocele formation is a very rare complication of this type of injury. We treated 43 pediatric patients with orbital roof fractures at our center over a 4-year period. The aim of this study was to retrospectively investigate conditions that may lead to intraorbital encephalocele formation in children with orbital roof fractures. Each case was reviewed, and the cause of injury, associated clinical and computerized tomography findings, the Glasgow Coma Scale score on admission, neurological status, other bodily injuries, hospitalization time and type and width of the orbital roof fracture were recorded. The findings in 6 patients who developed encephaloceles were compared to corresponding findings in the 37 patients who did not develop this complication. A total of 44 orbital roof fractures were diagnosed by axial and coronal computed tomography scanning. Six of the 43 children developed intraorbital encephaloceles in the first month after head trauma. In each of these cases, magnetic resonance imaging demonstrated the intraorbital cystic lesion in communication with the subarachnoid space. The width of each orbital roof fracture was measured on axial and coronal computed tomography slices and was confirmed by measurements during surgery. The width of the fractures in the encephalocele cases ranged from 2–4 mm. Duraplasty and orbitoplasty were performed in all the patients with encephalocele. Pediatric patients with orbital roof fractures that exhibit more than 2 mm diastasis and are associated with frontal cerebral contusion may be at greater risk for developing intraorbital encephalocele. All such cases should be monitored closely and investigated further with magnetic resonance imaging.

Intraorbital Encephalocele in an Adult Patient Presenting With Pulsatile Exophthalmos -Case Report-

“…2) Children with orbital roof fractures associated with frontal cerebral contusions are at greater risk for developing intraorbital encephaloceles. 5) This is in agreement with our intraoperative findings.…”

“…1,5) Orbital roof fractures were found in 7.1% of patients who suffered head injuries, and 13% of those patients developed intraorbital encephaloceles in the pediatric group. 5) All patients who developed intraorbital encephalocele after head injury showed pulsatile exophthalmos in this series.…”

“…7) Intraorbital encephaloceles, a type of basal encephalocele, are very rare and occur mostly in patients who have experienced head injuries, especially those resulting in orbital roof fractures. 2,4,5,8) The most common causes of intraorbital encephaloceles are trauma, tumors, and congenital skull malformations. 6,11) Treatment choices for intraorbital encephaloceles include surgical reconstruction of the skull base and duraplasty.…”

Traumatic orbitomaxillary encephalocele

“…Orbital fracture of 2 mm size with frontal contusion in children, are at greater risk of developing intraorbital encephalocele and need to be watched 1 . If the width is found to be 2-4 mm, then duraplasty and orbitoplasty is required to treat these children 1 . Localization of growing skull fracture to orbital roof region is even rare in adults 2 .…”

“…Orbital roof fractures are very uncommon and traumatic intra orbital encephalocele is further rare in mild blunt injury to head 1 . Similarly growing orbital fracture is also reported but as such quite a rare entity in adults 2 .…”