Persistent post-traumatic orbital cerebrospinal Fluid Fistula with multiple episodes of meningitis: Systematic Case Review and Case Report

Glaucia Suzanna Jong A Liem,Ana Carolina Maués De Oliveira,Carlos Dos Reis Lisboa-Neto,Eric Homero Albuquerque Paschoal,Manoel Jacobsen Teixeira,Fernando Mendes Paschoal Junior,Edson Bor-Seng-Shu

doi:10.3823/2050

Abstract

Title: Persistent post-traumatic orbital cerebrospinal fluid fistula with multiple episodes of meningitis: a systematic review and case report Background : Orbital cerebrospinal fluid (CSF) fistulas are very rare. Most of these fistulas spontaneously heal within a couple of days and usually do not require surgical repair. Furthermore, they present low rates of complications. Case presentation : We report a case of a 15-year-old boy that suffered a penetrating head trauma and developed multiple episodes of meningitis due to a persistent orbital and nasal CSF fistula. He underwent multiple different procedures to correct the dural breach: sphenoidal endoscopic approach, and three craniotomies, the last one succeeded with the placement of autologous grafts and biological glue. A lombar-subarachnoidal peritoneal shunt was placed to aid for 5 days. The CSF fistula ceased to drain and he recovered of the meningitis with additional standard antibiotics. Review : A systematic review in MedLine, Embase and Lilacs, identified 15 reported cases of persistent orbital CSF fistulas post-trauma. Traffic accidents were the most common mechanism of trauma. Most cases were in young boys and the main clinical manifestation was persistent “oculorrhea”. The CSF leaks were traced with CT-scans and were predominantly managed surgically. No fatal outcomes were reported. Conclusion: The reported cases raise awareness for persistent orbital CSF fistulas. Early diagnosis and adequate management is crucial to prevent complications, which are rare, but can be highly morbid and fatal.

Highlights

Cerebrospinal fluid (CSF) fistulas are a well-known complication of head trauma [1]
We report a case of a teenage boy, who developed posttraumatic orbital and nasal cerebrospinal fluid (CSF) fistulas
It is important to early diagnose and treat persistent orbital CSF fistulas

Summary

Conclusion

It is important to early diagnose and treat persistent orbital CSF fistulas. These fistulas are diagnosed by a suggestive clinical presentation (excessive tearing), CT-scans, lacrimal secretion testing and by CT-cisternography with metrizamide. Associated complications are rare, but when present can be highly morbid. This case report demonstrates a different surgical strategy to approach persistent CSF fistulas. We emphasize that the awareness and fundamental understanding of the lesion is essential to diagnose the condition for successful management. The patient’s legal guardian signed a consent form approving the submission of this case to the journal. The Ethics Board of the Ophir Loyola Hospital approved our report

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Discussion