Persistent post-traumatic orbital cerebrospinal Fluid Fistula with multiple episodes of meningitis: Systematic Case Review and Case Report

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 “oculorrhea”. 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.