Limawararut Vanessa, Valenzuela Alejandra A, Sullivan Timothy J, McNab Alan A, Malhotra Raman, Davis Garry, Jones Nigel, Selva Dinesh
Oculoplastic and Orbital Division, Department of Ophthalmology & Visual Sciences, University of Adelaide, Adelaide, Australia.
Surv Ophthalmol. 2008 May-Jun;53(3):274-84. doi: 10.1016/j.survophthal.2008.02.009.
Cerebrospinal fluid leakage is an uncommon but significant complication of orbital and rarely lacrimal surgery which may have serious consequences including death. In a retrospective review of four orbital units, we report an incidence of cerebrospinal fluid leak (diagnosed intraoperatively) during exenteration, orbital decompression, and dacryocystorhinostomy of 1/154 (0.6%), 4/397 (1%), and 0/3,504 (0%), respectively. We found two additional cases of cerebrospinal fluid leaks associated with excision of orbital masses involving the orbital roof. In the literature, the incidence of cerebrospinal fluid leaks associated with orbital exenterations and decompressions was 1.6-16.7% and 0-10%, respectively. Cerebrospinal fluid leaks occur very rarely in dacryocystorhinostomies with only a few case reports found in the literature. Preventative measures, diagnosis, and management of this complication are discussed. Knowledge of anatomy and thorough preoperative assessment may predict areas at high risk for encountering cerebrospinal fluid leaks. Proper surgical technique further minimizes the risk for this complication. If a cerebrospinal fluid leak occurs, however, prompt diagnosis and management usually results in uncomplicated recovery.
脑脊液漏是眼眶手术罕见但严重的并发症，泪道手术中则更为少见，可能会导致包括死亡在内的严重后果。通过对四个眼眶手术单元的回顾性研究，我们报告了在眶内容剜出术、眼眶减压术和泪囊鼻腔吻合术中脑脊液漏（术中诊断）的发生率分别为1/154（0.6%）、4/397（1%）和0/3504（0%）。我们还发现另外两例脑脊液漏与涉及眶顶的眼眶肿物切除有关。在文献中，与眶内容剜出术和眼眶减压术相关的脑脊液漏发生率分别为1.6% - 16.7%和0 - 10%。脑脊液漏在泪囊鼻腔吻合术中极为罕见，文献中仅有少数病例报告。本文讨论了该并发症的预防措施、诊断方法及处理手段。熟悉解剖结构并进行全面的术前评估有助于预测脑脊液漏的高危区域。正确的手术技巧可进一步降低该并发症的发生风险。然而，如果发生脑脊液漏，及时诊断和处理通常可使患者顺利康复。
