Traumatic cerebrospinal fluid oculorrhea managed with an external ventricular drain

Area of Science:

• Neurosurgery
• Trauma Surgery
• Ophthalmology

Background:

• Cerebrospinal fluid (CSF) leaks are rare but serious complications of head injuries.
• CSF oculorrhea, a leak of CSF from the eye due to a cranio-orbital fistula, is an exceptionally rare presentation.
• Standard management includes intracranial pressure control, CSF diversion, and surgical repair.

Observation:

• A 16-year-old male presented with an open comminuted depressed skull fracture and CSF oculorrhea.
• Initial conservative management with an external ventricular drain was initiated for CSF diversion.
• The patient had undergone a bifrontal decompressive craniectomy.

Findings:

• The external ventricular drain successfully diverted CSF, leading to effective conservative management.
• This represents the first reported use of an external ventricular drain for CSF diversion in the context of CSF oculorrhea secondary to cranio-orbital fistula.
• Surgical repair of the dural defect was ultimately successful.

Implications:

• External ventricular drains may offer a viable, less invasive option for CSF diversion in select cases of complex head injuries with CSF leaks.
• This approach could potentially reduce the need for more invasive CSF diversion methods like lumbar drains in specific scenarios.
• Further research is warranted to explore the efficacy and safety of EVDs in managing CSF leaks with oculorrhea.