Delayed-Onset Traumatic Orbital Pseudo meningocele in a Pediatric Patient: Diagnosis and Surgical Management
Author: İbrahim Edhem Yılmaz
Base Hospital / Institution: City Referral Hospital / Gaziantep Islam Science and Technology University
ePoster presentation
Abstract ID: 25-448
Purpose
To report the clinical presentation, diagnostic approach, and surgical management of a delayed-onset traumatic cranio-orbital cerebrospinal fluid (CSF) fistula causing pseudomeningocele in a 1-year-old female following head trauma, emphasizing the importance of clinical vigilance in pediatric orbital trauma cases.
Methods
A 1-year-old girl who sustained head trauma in a motorcycle accident initially presented with a Glasgow Coma Scale score of 8, right periorbital hematoma, and proptosis. Three months post-trauma, she developed progressive right-sided ptosis, proptosis, and limited upward gaze. Magnetic resonance imaging revealed a cystic lesion (2.5 × 2 × 1.5 cm) at the right orbital roof consistent with CSF accumulation. Surgical intervention via superior orbitotomy was performed, with defect repair using bone wax and fibrin glue.
Results
Intraoperatively, a cystic lesion containing clear fluid was identified in the superior orbit. Fluid analysis confirmed CSF composition. The orbital roof defect (0.8 cm diameter) was successfully repaired. Postoperatively, the patient exhibited immediate improvement in proptosis and gradual improvement in ocular motility. At five-month follow-up, complete resolution of proptosis and ptosis was observed, with improved upward gaze and no recurrence on imaging
Conclusion
This case highlights that traumatic cranio-orbital CSF fistulas can present with delayed onset in pediatric patients following craniofacial trauma. The thin orbital roof in children makes them particularly susceptible to this rare complication. A high index of suspicion, appropriate imaging with MRI, and timely surgical intervention are crucial for successful management. Although uncommon, this entity should be considered in the differential diagnosis of progressive orbital symptoms following pediatric head trauma, even months after the initial injury
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Alper | Afşer | Toros Hospital/Mersin |
| Şeyhmus | Arı | Private Practice / Gaziantep |
