Purpose

Cerebrospinal fluid (CSF) leak and complications following dacryocystorhinostomy (DCR) are rare. We present four cases with computed tomography (CT) radiological findings and post-operative outcomes.

---

Methods

Multi-centre retrospective case series.

---

Results

1: A 79-year-old female underwent left enDCR for NLDO in a narrow nasal cavity without intraoperative complications. Three days later, she presented with bacterial meningitis. CT showed transverse venous sinus thrombosis, pneumoencephalocele, and a breach in the cribriform plate at its middle turbinate insertion. She received intravenous antibiotics and fully recovered at 3 months. 2: A 74-year-old man underwent left enDCR for a mucocoele. Brief unsupervised superior osteotomy resulted in bleeding requiring nasal tamponade. Post-operative persistent epistaxis and CSF rhinorrhoea prompted a CT that demonstrated pneumoencephalocele with a large medial orbital wall defect extending posteriorly. He developed bacterial meningitis and died two weeks later despite intravenous antibiotics. 3: A 48-year-old man underwent right enDCR for NLDO without intraoperative complications. He developed headache and vomiting on day 1. CT showed right frontal lobe intraparenchymal haematoma, pneumocephalus and a fovea ethmoidalis defect. He underwent transnasal skull base repair but developed a frontal sinus mucocele 5 years later. 4: A 50-year-old female underwent left extDCR for NLDO. Intraoperatively, superior dissection was limited by reduced surgical space, otherwise routine. Post-operatively, she developed worsening headache and epistaxis over 48hours. CT demonstrated pneumocephalus and fovea ethmoidalis fracture. She recovered after a course of intravenous antibiotics.

---

Conclusion

Consequential complications of CSF breach following DCR should be counselled to patients. Associated factors include surgeons early in their learning curve, narrow nasal passages, and posterior osteotomy within the ethmoid air cells or medially on the middle turbinate. Often unrecognised intraoperatively, post-operative headache should alert clinicians.

---

Additional Authors

First name	Last name	Base Hospital / Institution
Samir	Mohapatra	Corneoplastic Unit, Queen Victoria Hospital, East Grinstead, RH19 3DZ, UK
Andre	Litwin	Corneoplastic Unit, Queen Victoria Hospital, East Grinstead, RH19 3DZ, UK
Raman	Malhotra	Corneoplastic Unit, Queen Victoria Hospital, East Grinstead, RH19 3DZ, UK

↑ Back to top