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Cerebrospinal fluid leakage complicating orbital exenteration
A E Wulc1, J L Adams, R M Dryden
1Oculoplastic/Orbital Service, Scheie Eye Institute, Hospital of the University of Pennsylvania, Philadelphia 19104.
Archives of Ophthalmology (Chicago, Ill. : 1960)
|June 1, 1989
Summary
Cerebrospinal fluid leakage during orbital exenteration can occur from monopolar cautery. Thermal energy transmitted through orbital roof defects can disrupt the dura, necessitating alternative hemostasis methods.
Area of Science:
- Ophthalmology
- Neurosurgery
- Surgical Oncology
Background:
- Orbital exenteration is a surgical procedure to remove the orbital contents.
- Cerebrospinal fluid (CSF) leakage is a potential complication following orbital exenteration.
- Monopolar cautery is frequently used for hemostasis during such procedures.
Observation:
- Three cases of CSF leakage were observed during orbital exenteration using low-power monopolar cautery on the orbital roof.
- Cadaveric and dried skull studies were performed to investigate the mechanism of CSF leakage.
- Cautery applied directly to the orbital roof did not cause leakage, but cautery to pre-existing or created bone defects did.
Findings:
- Intraoperative CSF leakage during orbital exenteration is linked to monopolar cautery.
- Thermal energy from monopolar cautery can transmit through defects in the orbital roof to the dura.
- These defects can be congenital, tumor-related, or iatrogenic, leading to dural disruption.
Implications:
- Alternative hemostasis techniques should be considered for bleeding along the orbital roof during exenteration.
- Understanding the role of thermal spread through orbital defects is crucial for preventing CSF leakage.
- This research highlights the importance of careful technique and consideration of anatomical variations during orbital surgery.