Dr. Santanu Das

Dr.Raghuraj S Hegde

Abstract

Purpose-To demonstrate the treatment of CSF leak during orbital exenteration

Synopsis:An elderly male presented to us with left lower eyelid swelling for 2 years gradually increasing in size. Diagnostic biopsy revealed sebaceous cell carcinoma.MRI showed intraorbital spread. Lid sparing orbital exenteration was planned.During the surgery CSF leak was noted from the stump of the optic nerve. Fascia lata harvested from the right thigh was used to seal the leak.He was adviced complete bed rest along with intravenous antibiotics.Post discharge he complained of headache with CSF rhinorrhoea.He was readmitted and treated with i.v. antibiotics, bed rest with head end elevation and Acetazolamide.Lumbar puncture was normal. His symptoms subsided after a week and was discharged.

Conclusion-CSF leak is rare but can be life threatening.Intraoperative sealing with fascia lata is most effective followed by conservative management.In recalcitrant cases lumbar drain and surgical closure can be done.