Late Surgical Management Of A Rare Case Of Post-traumatic Orbital Encephalocele

Orbital roof fractures after blunt head trauma are not uncommon. Hernia ion of the brain tissues into the orbit through a bony defect, so-called post-traumatic orbital encephalocele, is a rare entity. The herniated braint issue causes compression of the intraorbital contents, particularly the optic nerve, extraocular nerves and muscles and compromise the vascular supply. Raisedintraorbital pressure may lead to irreversible damage to the optic nerve. This can be prevented by early diagnosis and timely management. Repair of the orbital roof needs to be performed to avoid transmission of intracranial pressure into the orbit. Early intervention is needed in order to prevent visual loss. We present a case of posttraumatic orbital encephalocele who underwent latesurgical treatment with direct repair of dura opening, reinforcement with temporalis fascia and reconstruction of orbital roof using skull bone graft. Complete resolution of the pulsatile proptosis with excellent cosmetic result was observed at follow up. However, the visual diminution did not recover significantly due to late diagnosis and intervention. Early diagnosis and surgical management of this rare condition can prevent permanent visual loss and also achieve good cosmetic results.

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Post-traumatic bronchobiliary fistula

BMJ Case Reports ◽

10.1136/bcr-2018-228294 ◽

2019 ◽

Vol 12 (4) ◽

pp. e228294 ◽

Cited By ~ 2

Author(s):

Niladri Banerjee ◽

Amulya Rattan ◽

Pratyusha Priyadarshini ◽

Subodh Kumar

Keyword(s):

Early Diagnosis ◽

Surgical Management ◽

Gold Standard ◽

Complete Recovery ◽

Rare Entity ◽

Bronchobiliary Fistula ◽

Confirmatory Tests ◽

Post Traumatic ◽

Torso Trauma ◽

Individualised Treatment

Post-traumatic bronchobiliary fistula (BBF) is a rare entity, with only a few cases reported worldwide. Bilioptysis is pathognomonic of the condition, however, bronchoscopy and bronchoalveolar lavage along with CT are used for confirmation. We describe this condition in a young woman who presented to us with bilioptysis following a laparotomy for blunt torso trauma. Diagnosis was made of BBF, followed by surgical management and complete recovery. We emphasise the signs of early diagnosis, confirmatory tests, individualised treatment and advocate surgical management as the gold standard of treatment.

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Aqueous misdirection syndrome masking as myopic surprise following phacoemulsification surgery

BMJ Case Reports ◽

10.1136/bcr-2021-242777 ◽

2021 ◽

Vol 14 (12) ◽

pp. e242777

Author(s):

Chung Shen Chean ◽

Duminda Gabadage ◽

Subhanjan Mukherji

Keyword(s):

Intraocular Pressure ◽

Optic Nerve ◽

Early Diagnosis ◽

Cataract Surgery ◽

Anterior Chamber ◽

Surgical Management ◽

Clinical Presentation ◽

Optic Nerve Damage ◽

Shallow Anterior Chamber ◽

Aqueous Misdirection

Aqueous misdirection syndrome is a rare but serious condition that can present after routine phacoemulsification surgery. This report examines a case of myopic surprise following an uncomplicated left eye (LE) phacoemulsification surgery. The patient had previous bilateral peripheral iridotomies for narrow anterior chamber angles. Repeat biometry measurement of the pseudophakic LE did not show shallow anterior chamber, and intraocular pressure (IOP) was normal at initial presentation. However, approximately 3 years postoperatively, LE IOP was raised. Surgical management was considered as medical and laser procedures did not stop deterioration. Clinical presentation of aqueous misdirection syndrome may be subtle and can occur weeks to years after routine uncomplicated phacoemulsification surgery. Myopic surprise may be the only initial presenting sign. Patients who are at risk of aqueous misdirection syndrome should be followed up closely after cataract surgery with accurate gonioscopic assessments for early diagnosis and treatment to prevent optic nerve damage.

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P.116 Orbital lymphaticovenous malformation with intradural extension: a rare case

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2018.218 ◽

2018 ◽

Vol 45 (s2) ◽

pp. S47-S47

Author(s):

M Abbass ◽

MK Tso ◽

E Weis ◽

AP Mitha

Keyword(s):

Surgical Management ◽

Orbitofrontal Cortex ◽

Rare Case ◽

Interdisciplinary Approach ◽

Vascular Lesions ◽

Bony Defect ◽

Vascular Structure ◽

Orbital Roof ◽

First Case ◽

Orbitozygomatic Approach

Orbital lymphaticovenous malformations (LVM) are congenital vascular lesions that are typically infiltrative in nature. There have been reports of orbital LVMs extending intracranially through orbital fissures, but there have been no reports of intradural extension that we are aware of. We present the case of an otherwise healthy 25-year-old female with an orbital LVM extending intradurally. Imaging revealed an intraorbital lesion extending through a bony defect in the medial orbital roof to the orbitofrontal cortex. A modified orbitozygomatic approach was used to obliterate this lesion. A durotomy was created to examine the intradural extension of the lesion, which appeared as a lobulated red vascular structure emanating from the dura along the roof of the orbit. This was gradually and comprehensively bipolar coagulated and subsequently obliterated. Neurosurgical and ophthalmological collaboration was used in the surgical management of this case. In summary, we report the first case of an orbital LVM extending intradurally, and provide pre and post-operative imaging as well as images captured through the intraoperative microscope. Through this case we highlight the importance of an interdisciplinary approach when managing orbital LVMs, as both ophthalmological and neurosurgical expertise were critical in the success of the surgery.

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Acute traumatic orbital encephalocele: A case report with review of literature

Journal of Neurosciences in Rural Practice ◽

10.4103/0976-3147.120209 ◽

2013 ◽

Vol 04 (04) ◽

pp. 467-470 ◽

Cited By ~ 7

Author(s):

Manish Jaiswal ◽

I. Vijay Sundar ◽

Ashok Gandhi ◽

Devendra Purohit ◽

R. S. Mittal

Keyword(s):

Surgical Treatment ◽

Early Diagnosis ◽

Rare Condition ◽

Blunt Injury ◽

Trauma Patients ◽

Orbital Trauma ◽

Orbital Cavity ◽

Irreversible Damage ◽

Orbital Roof ◽

Bone Powder

ABSTRACTOrbital roof fractures after a blunt injury are an uncommon complication of trauma. Traumatic encephaloceles in the orbital cavity are even rarer, with only 15 cases published till date. Raised intraorbital pressure leading to irreversible damage to the optic nerve can be prevented by early diagnosis and management. Orbital computed tomography (CT) with thin axial and coronal sections is helpful in trauma patients with a concurrent orbital trauma. Decompression of the orbital roof is the key step in surgical treatment and should be performed in every case. Repairing the orbital roof has to be performed to avoid transmission of variation in the intracranial pressure to the orbit. We present a case of traumatic orbital encephalocele who underwent surgical treatment via a frontobasal approach with evacuation of the contused herniated brain and reconstruction of the orbital roof using temporalis fascia which is readily available in contrast to costly materials like titanium mesh, screws, bone powder, fibrin glue, and so on, which are not easily available in every hospital. Rapid resolution of proptosis and visual symptoms along with excellent cosmetic outcome was seen at follow‑ups after three and nine months. We emphasize the early diagnosis of this rare condition and also emergency treatment to prevent permanent visual loss as well as to achieve good cosmetic results.

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Optic Disc Preprocessing for Reliable Glaucoma Detection in Small Datasets

Mathematics ◽

10.3390/math9182237 ◽

2021 ◽

Vol 9 (18) ◽

pp. 2237

Author(s):

José E. Valdez-Rodríguez ◽

Edgardo M. Felipe-Riverón ◽

Hiram Calvo

Keyword(s):

Neural Networks ◽

Optic Nerve ◽

Early Diagnosis ◽

Optic Disc ◽

Convolutional Neural Networks ◽

Visual Loss ◽

Depth Information ◽

Optical Images ◽

Glaucoma Detection ◽

Small Dataset

Glaucoma detection is an important task, as this disease can affect the optic nerve, and this could lead to blindness. This can be prevented with early diagnosis, periodic controls, and treatment so that it can be stopped and prevent visual loss. Usually, the detection of glaucoma is carried out through various examinations such as tonometry, gonioscopy, pachymetry, etc. In this work, we carry out this detection by using images obtained through retinal cameras, in which we can observe the state of the optic nerve. This work addresses an accurate diagnostic methodology based on Convolutional Neural Networks (CNNs) to classify these optical images. Most works require a large number of images to train their CNN architectures, and most of them use the whole image to perform the classification. We will use a small dataset containing 366 examples to train the proposed CNN architecture and we will only focus on the analysis of the optic disc by extracting it from the full image, as this is the element that provides the most information about glaucoma. We experiment with different RGB channels and their combinations from the optic disc, and additionally, we extract depth information. We obtain accuracy values of 0.945, by using the GB and the full RGB combination, and 0.934 for the grayscale transformation. Depth information did not help, as it limited the best accuracy value to 0.934.

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Surgical Management of Post-Traumatic Neuropathic Pain

Neurosurgery Clinics of North America ◽

10.1016/s1042-3680(18)30761-7 ◽

1991 ◽

Vol 2 (1) ◽

pp. 117-126 ◽

Cited By ~ 26

Author(s):

Kim J. Burchiel ◽

Jose L. Ochoa

Keyword(s):

Neuropathic Pain ◽

Surgical Management ◽

Post Traumatic

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Novel in vivo depiction of optic nerves hemorrhages in child abuse: a 3D-SWI pilot study

Neuroradiology ◽

10.1007/s00234-020-02622-6 ◽

2021 ◽

Author(s):

Giulio Zuccoli

Keyword(s):

Optic Nerve ◽

Mass Effect ◽

Abusive Head Trauma ◽

Superficial Siderosis ◽

Susceptibility Artifacts ◽

Female Ratio ◽

Optic Nerves ◽

Statistical Correlations ◽

Post Traumatic

Abstract Purpose Until now, the diagnosis of optic nerves hemorrhages in abusive head trauma (AHT) has been obtained only in the postmortem setting. The aim of the IRB-approved study was to assess the presence of optic nerves hemorrhages in AHT patients using 3D-SWI. Methods Thirteen children with a final confirmed multidisciplinary diagnosis of AHT underwent coronal and axial 3D-SWI imaging of the orbits. The presence of optic nerve sheath (ONS) hemorrhages was defined by thickening and marked 3D-SWI hypointensity of the ONS, resulting in mass effect upon the CSF space. Optic nerve (ON) hemorrhages were defined by areas of susceptibility artifacts in the ON parenchyma. Superficial siderosis was defined by susceptibility artifact coating the ON. Furthermore, data about post-traumatic deformity of the ONS at the head of the optic nerve were collected. Results The average age of the population was 7.9 ± 5.9 months old. The average GCS was 11.8 ± 4.5. The male to female ratio was 7:6. ONS hemorrhages were identified in 69.2% of cases. Superficial siderosis and ON hemorrhages were identified in 38.5 and 76.9% of cases, respectively. 3D-SWI also depicted traumatic deformity of the ONS at the level of the optic nerve head in 10 cases (76.9%). No statistical correlations were identified between RetCam findings and 3D-SWI findings or GCS and ON hemorrhages. Conclusion This research shows that dedicated MRI with volumetric SWI of the orbits can depict hemorrhages in the ON, ONS, and ONS injury, in AHT victims.

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Choroidal microvasculature dropout is spatially associated with optic nerve head microvasculature loss in open-angle glaucoma

Scientific Reports ◽

10.1038/s41598-021-94755-8 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Min Kyung Song ◽

Joong Won Shin ◽

Jin Yeong Lee ◽

Ji Wook Hong ◽

Michael S. Kook

Keyword(s):

Optic Nerve ◽

Optic Nerve Head ◽

Optical Coherence Tomography Angiography ◽

Open Angle Glaucoma ◽

Spatial Relationship ◽

Vascular Supply ◽

Open Angle ◽

Regression Analyses ◽

Angular Extent ◽

Choroidal Vessels

AbstractThe presence of parapapillary choroidal microvasculature dropout (CMvD) may affect optic nerve head (ONH) perfusion in glaucoma patients, since parapapillary choroidal vessels provide vascular supply to the neighboring ONH. However, it remains to be determined whether the presence of parapapillary CMvD is associated with diminished perfusion in the nearby ONH. The present study investigated the spatial relationship between CMvD and ONH vessel density (ONH-VD) loss in open-angle glaucoma (OAG) eyes using optical coherence tomography angiography (OCT-A). This study included 48 OAG eyes with a single localized CMvD confined to the inferotemporal parapapillary sector and 48 OAG eyes without CMvD, matched for demographic and ocular characteristics. Global and regional ONH-VD values were compared between eyes with and without CMvD. The relationships between ONH-VD outcomes and clinical variables were assessed. ONH-VDs at the inferotemporal ONH sectors corresponding to the CMvD location were significantly lower in eyes with compared to those without CMvD. Multivariable linear regression analyses indicated that a lower inferotemporal ONH-VD was independently associated with CMvD presence and a greater CMvD angular extent (both P < 0.05). The localized presence of parapapillary CMvD in OAG eyes is significantly associated with ONH-VD loss in the neighboring ONH location, with a spatial correlation.

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