Cerebrospinal fluid leak from lateral orbit during exenteration for mucormycosis

• Published in: BMJ case reports Vol. 13; no. 9; p. e237575
• Main Authors: Arora, Kanika, Mehta, Aditi, Virk, Ramandeep Singh, Saini, Manu
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 13.09.2020; BMJ Publishing Group
• Subjects: Administration, Intravenous; Amphotericin B - administration & dosage; Antifungal Agents - administration & dosage; Blepharoptosis - microbiology; Blindness - microbiology; Bones; Case reports; Cerebrospinal fluid; Cerebrospinal Fluid Leak - diagnosis; Cerebrospinal Fluid Leak - etiology; Cerebrospinal Fluid Leak - surgery; Debridement; Diabetes; Diabetes Mellitus, Type 2 - immunology; Diabetic retinopathy; Dissection; Ears & hearing; Endoscopy; Fractures; Fungal infections; Humans; Hyphae - isolation & purification; Infections; Intraoperative Complications - diagnosis; Intraoperative Complications - etiology; Intraoperative Complications - surgery; Lessons Learned; Magnetic Resonance Angiography; Male; Metabolism; Middle Aged; Mucormycosis - complications; Mucormycosis - immunology; Mucormycosis - microbiology; Mucormycosis - therapy; Orbit - diagnostic imaging; Orbit - microbiology; Orbit - surgery; Orbit Evisceration - adverse effects; Orbital Diseases - complications; Orbital Diseases - diagnosis; Orbital Diseases - microbiology; Orbital Diseases - therapy; Paranasal Sinuses - diagnostic imaging; Paranasal Sinuses - microbiology; Paranasal Sinuses - surgery; Retinal Artery Occlusion - diagnosis; Retinal Artery Occlusion - microbiology; Sinuses; Sinusitis - complications; Sinusitis - immunology; Sinusitis - microbiology; Sinusitis - therapy; Surgery; Treatment Outcome; Veins & arteries; otolaryngology / ENT; ophthalmology; oral and maxillofacial surgery; ear; infectious diseases; nose and throat/otolaryngology
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2020-237575

We describe an elderly diabetic patient presenting with sudden onset right-sided proptosis and vision loss secondary to rhino-orbital mucormycosis and central retinal vascular occlusion. He underwent orbital exenteration that was complicated by intraoperative cerebrospinal fluid (CSF) leak from lateral orbital wall. The leak was surgically repaired and the patient recovered well. We postulate the cause of the CSF leak to be twofold: necrotic periorbital tissue due to mucormycosis rendering the thin bones susceptible to damage and second, intraoperative manipulation and dissection at the orbital apex with monopolar cautery and instruments. We describe measures taken to successfully repair the CSF leak and the possible precautions that can be taken to avoid it.