Periorbital Cerebrospinal Fluid Collection after Orbital Roof Craniotomy and Superolateral Orbital Craniotomy.

Kwon, Young Hoon; Park, Jeong Hyun; Lee, Jong Sun; Park, Moon Sun; Ha, Ho Gyun

Original Article

Journal of Korean Neurosurgical Society 2003;33(1): 62-66.

Young Hoon Kwon, Jeong Hyun Park, Jong Sun Lee, Moon Sun Park, Ho Gyun Ha

Department of Neurosurgery, Eulji University School of Medicine, Daejeon, Korea. jslee@eulji.ac.kr

ABSTRACT

OBJECTIVE
The aims of this study are to review the incidence of cerebrospinal fluid(CSF) collection complicating the simplified anterior skull base approaches via an eyebrow incision and to identify factors that influence its occurrence and treatment. METHODS: The authors retrospectively analyzed the clinical records and radiologic data of 47 cases(45 patients) who underwent superolateral orbital craniotomy or orbital roof craniotomy via an eyebrow incision at the Eulji Medical Center from September 1998 to August 2002. Forty-three cases were anterior circulation aneurysms and four cases were brain tumors. RESULTS: Significant periorbital CSF collection occurred in 13 cases(11 aneurysms, 2 brain tumors). It was managed with aspiration(8 cases), aspiration and lumbar drainage(2 cases), and dural repair(3 cases). There was no statistically significant difference in operative approaches and patient's characteristics. Periorbital CSF collection occurred in one(16.7%) of six cases using preventive lumbar CSF drainage over two days and in 12 (29.3%) out of 41 cases without it(p>005). CONCLUSION: The authors suggest that careful dissection and water-tight closure of frontal dura, sealing with fibrin glue and compressive dressing of operative wounds are important for the prevention of this complication. However, statistically not significant, preventive lumbar CSF drainage seem to be effective. Aspiration and/or lumbar drainage seem to be sufficient for management of postoperative CSF collection and dural repair could be reserved for refractory cases.

Key Words: Superolateral orbital craniotomy; Orbital roof craniotomy; Eyebrow incision; Periorbital CSF collection; Preventive lumbar CSF drainage