Persistent Post-Traumatic Orbital Cerebrospinal Fluid Fistula with Multiple Episodes of Meningitis: Systematic Case Review and Case Report


  • Glaucia Suzanna Jong A Liem Faculty of Medicine, Universidade do Estado do Pará, Belém, PA, Brazil
  • Carlos dos Reis Lisboa-Neto Division of Neurosurgery, Hospital Ophir Loyola, Belém, PA, Brazil
  • Fernando Mendes Paschoal Junior Division of Neurology and Neurosurgery, Hospital Universitário João de Barros Barreto da Universidade Federal do Pará, Belém, PA, Brazil
  • Ana Carolina Maués de Oliveira Faculty of Medicine, Universidade do Estado do Pará, Belém, PA, Brazil
  • Edson Bor-Seng-Shu Division of Neurosurgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
  • Manoel Jacobsen Teixeira Division of Neurosurgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
  • Eric Homero Albuquerque Paschoal Division of Neurosurgery, Hospital Ophir Loyola, Belém, PA, Brazil



CSF fistula, CSF leak, TBI, complications, meningitis, adolescent, oculorrhea


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 “oculorrheaâ€. 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.

Author Biography

Eric Homero Albuquerque Paschoal, Division of Neurosurgery, Hospital Ophir Loyola, Belém, PA, Brazil

Vascular neurosurgeon and neuroradiology interventionist



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