Traumatic cerebrospinal fluid oculorrhea managed with an external ventricular drain

Abstract

Cerebrospinal fluid (CSF) leaks following head injuries are rare complications with significant morbidity and mortality if left untreated. CSF oculorrhea secondary to a cranio-orbital fistula is a rare presentation of this complication. Standard treatment for a CSF leak involves management of intracranial pressure, CSF diversion and surgical repair of any dural defect. Lumbar drains have commonly been inserted to aid in diverting CSF. We describe a case of a 16-year-old male who presented with an open comminuted depressed skull fracture and CSF oculorrhea. Following a bifrontal decompressive craniectomy, he was successfully treated with CSF diversion following a conservative trial using an external ventricular drain. The use of an external ventricular drain for this purpose has not been described in the literature to date. We report this case as a method of demonstrating the use of an external ventricular drain to adequately divert CSF.

Post-traumatic orbitorrhea: An underestimated life-threatening complication following anterior skull base fractures

“…3 Conservative treatment includes lumbar drainage and sometimes ventricular drainage and bed rest. 2,4,5 In many cases, conservative treatment can be initially attempted. A recent literature review on orbitorrhea highlighted that 25% of patients were initially treated by conservative treatment with a success rate of 86%.…”

Delayed Occurrence of CSF Oculorrhea after Mild Blunt Traumatic Head Injury

“…The delayed CSF oculorrhea can be explained by the persistent fistula between the cranium and orbit 10) , but to establish the diagnosis of cranio-orbital fistula can be challenging because of the difficulty in differentiating oculorrhea from excessive lacrimation caused by orbital soft tissue trauma or epiphora caused by lacrimal outflow obstruction 2) .…”

“…We suggest that CSF diversion is proper method for the management of a traumatic cranio-orbital fistula 6) . CSF diversion can be performed continuous lumbar drainage for up to 10 days 10) . In spite of continuous lumbar drainage, if the CSF continues to leak, a surgical approach can be taken to primarily repair the dural defect 8,10) .…”