Cerebrospinal Fluid Leak as a Complication of Oculoplastic Surgery

PURPOSE: Cerebrospinal fluid leak is a rare, but potentially morbid complication of orbital surgery. In this review, we analyze the reported cases of CSF leak in such surgeries, determine their causes, clinical presentations and sequellae, and highlight the different methods to detect and manage them. METHODS: A comprehensive literature review was conducted in PubMed. RESULTS: Twenty-one cases of CSF leak occurred with orbital exenteration, 34 with orbital decompression, four with DCR, two with enucleation, and four cases with other skull base surgery. Operating in high-risk areas increased the risk of dural injury. Once detected, CSF leak was either controlled by bed rest and head elevation or required a surgical repair. The various techniques of surgical management are discussed. CONCLUSION: The number of reported surgical CSF leaks in the orbit is relatively low. To prevent this complication, it is essential to have intimate knowledge of orbital anatomy, especially in the setting of pre-existing abnormalities. If CSF leak occurs, it should be rapidly recognized and adequately managed to prevent further morbidity.