Traumatic cerebrospinal fluid oculorrhea managed with an external ventricular drain.

Cerebrospinal fluid (CSF) leaks following head injuries are rare complications with significant morbidity and mortality if left untreated. CSF oculorrhea secondary to a cranio-orbital fistula is a rare presentation of this complication. Standard treatment for a CSF leak involves management of intracranial pressure, CSF diversion and surgical repair of any dural defect. Lumbar drains have commonly been inserted to aid in diverting CSF. We describe a case of a 16-year-old male who presented with an open comminuted depressed skull fracture and CSF oculorrhea. Following a bifrontal decompressive craniectomy, he was successfully treated with CSF diversion following a conservative trial using an external ventricular drain. The use of an external ventricular drain for this purpose has not been described in the literature to date. We report this case as a method of demonstrating the use of an external ventricular drain to adequately divert CSF.

Vertebral artery dissection following a posterior cervical foraminotomy.

Vertebral artery dissection following a posterior cervical foraminotomy with rhizolysis of the subaxial spine has not been described before. A 46-year-old lady underwent the procedure for a left C6 radiculopathy with a focal disc herniation with no intraoperative complications. Seven hours post-operatively, she developed a right homonymous hemianopia, thalamic dysphasia, gait and memory impairment. Imaging demonstrated an occlusion to the left vertebral artery from C7/T1 to C4 with a dissection flap noted at the inferior margin. This was further complicated with thrombosis of the dissected artery and subsequent emboli causing acute posterior circulation infarctions. Given that the dissection occurred at the level of the surgery, an indirect surgical cause is likely. We hypothesize that the vibration transmitted via bone from the high-speed drill led to arterial injury and dissection.