Yoon Michael K, Piluek Wachirapon Jordan, Ruggiero Jason P, McDermott Michael W, McCulley Timothy J
Department 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.
J Neuroophthalmol. 2014 Dec;34(4):346-9. doi: 10.1097/WNO.0000000000000125.
We describe 2 patients who developed postoperative orbital cerebrospinal fluid (CSF) collection after orbitozygomatic pterional craniotomy. An 18-year-old woman underwent exploratory pterional-orbitozygomatic craniotomy. Five days postoperatively, after removal of a lumbar drain, proptosis and a compressive optic neuropathy developed. Computed tomography demonstrated a CSF collection contiguous with the craniotomy site. Resolution followed percutaneous aspiration and replacement of the lumbar drain. A 57-year-old woman underwent a pterional-orbitozygomatic craniotomy for removal of a left anterior clinoid meningioma, complicated by a large left hemorrhagic stroke requiring decompressive hemicraniectomy. Extracranial CSF collections accumulated in both the orbit and subgaleal spaces. Resolution followed placement of an external ventricular drain. Based on these cases, the mechanism seems to be the combination of iatrogenic formation of a communication with the subarachnoid space and elevated intracranial pressure. Resolution was achieved by normalizing intracranial pressure.
我们描述了2例在眶颧翼点入路开颅术后出现眶内脑脊液（CSF）聚集的患者。一名18岁女性接受了探查性翼点-眶颧开颅手术。术后5天，拔除腰大池引流管后，出现眼球突出和压迫性视神经病变。计算机断层扫描显示脑脊液聚集与开颅部位相邻。经皮抽吸并重新放置腰大池引流管后病情缓解。一名57岁女性接受了翼点-眶颧开颅手术以切除左侧前床突脑膜瘤，并发大型左侧出血性中风，需要进行减压性颅骨切除术。颅外脑脊液聚集在眼眶和帽状腱膜下间隙。放置外部脑室引流管后病情缓解。基于这些病例，其机制似乎是医源性形成与蛛网膜下腔的交通以及颅内压升高的综合作用。通过使颅内压正常化实现了病情缓解。
