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Orbital cerebrospinal fluid accumulation after complicated pterional-orbitozygomatic craniotomy
Michael K Yoon1, Wachirapon Jordan Piluek, Jason P Ruggiero
1Department of Ophthalmology (MKY), Harvard Medical School, Boston, Massachusetts; Ophthalmic Plastic Surgery, Massachusetts Eye and Ear Infirmary (MKY), Boston, Massachusetts; Wilmer Eye Institute (WJP, TJM), Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Ophthalmology (JPR), University of Pennsylvania, Philadelphia, Pennsylvania; and Department of Neurological Surgery (MWM), University of California, San Francisco, California.
Orbital cerebrospinal fluid (CSF) collection can occur after pterional-orbitozygomatic craniotomy. Management involves addressing CSF leaks and normalizing intracranial pressure to achieve resolution.
Area of Science:
- Neurosurgery
- Ophthalmology
Background:
- Orbitozygomatic pterional craniotomy is a complex neurosurgical procedure.
- Postoperative complications require careful monitoring and management.
Observation:
- Two patients developed orbital cerebrospinal fluid (CSF) collection after orbitozygomatic pterional craniotomy.
- Symptoms included proptosis and compressive optic neuropathy.
Findings:
- CSF collection was contiguous with the craniotomy site and associated with elevated intracranial pressure.
- Resolution was achieved through percutaneous aspiration, lumbar drain replacement, or external ventricular drain placement.
Implications:
- Iatrogenic communication with the subarachnoid space and elevated intracranial pressure are likely mechanisms.
- Normalizing intracranial pressure is key to resolving orbital CSF collections post-craniotomy.
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