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Post-traumatic intra-orbital meningoencephalocele in adults: technical note on a rare entity and review of the literature

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Abstract

Post-traumatic orbital meningoencephaloceles related to orbital roof fractures are a challenging clinical entity because of their rarity and difficult differential diagnosis. We report a case of post-traumatic intra-orbital meningoencephalocele in a 69-year-old man, secondary to a likely trapdoor mechanism, treated with a modified one-piece orbitozygomatic craniotomy. We also performed an extensive literature review of traumatic Intra-Orbital Encephalocele related to Orbital Roof Fracture focused on adult patients on electronic databases including Scopus, MEDLINE/PubMed, and Google Scholar. Patient well recovered after surgery with immediate exophthalmos resolution and discharged without visual or neurological deficits. The literature review included 22 papers with a total of 28 patients: 22 males (78.6%) and 6 females (21.4%), with a median age of 34.7 years. Twenty-six patients (92.9%) reported ocular injuries, with associated intracranial complications in 16 cases (61.5%). Twenty-seven patients (96.4%) were surgically treated, 18 of those underwent unilateral or bilateral frontal approach. Most orbital roof fractures can be managed nanoperatively if asymptomatic. Indeed, when the intra-orbital volume decreases, for example due to an encephalocele, the intra-orbital pressure could increase and determine an orbital compartment syndrome. In our case, we performed a one-piece modified orbitozygomatic approach, which has several advantages in comparison to the frequent unilateral or bilateral frontal craniotomy like the better exposure of the brain and orbit and a minimum brain retraction.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Acknowledgements

The authors wish to thank the Scientific Bureau of the University of Catania for language support.

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Authors and Affiliations

  1. Department of Neurological Surgery, Polyclinic “G. Rodolico-S. Marco” University Hospital, Viale Carlo Azeglio Ciampi 1, 95121, Catania, Italy

    Giacomo Cammarata, Roberto Altieri, Francesco Certo, Luca Petrella, Angelo Basile, Aurora Pizzo & Giuseppe Barbagallo

  2. Interdisciplinary Research Center On Brain Tumors Diagnosis and Treatment, University of Catania, Catania, Italy

    Roberto Altieri, Francesco Certo & Giuseppe Barbagallo

  3. PhD Program at Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Turin, Italy

    Roberto Altieri

  4. Department of General Surgery, Section of Maxillo Facial Surgery of Polyclinic “G. Rodolico – San Marco” University Hospital, University of Catania, Catania, Italy

    Salvatore Crimi, Salvatore Battaglia & Alberto Bianchi

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  1. Giacomo Cammarata
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  2. Roberto Altieri
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Contributions

Roberto Altieri conceived and planned the study. Giacomo Cammarata, Aurora Pizzo, and Angelo Basile did the literature retrieve. Giacomo Cammarata, Aurora Pizzo, and Angelo Basile applied selection criteria, extracted data, and evaluated study quality. Giacomo Cammarata synthesized the data and wrote the initial draft of the manuscript. All authors critically reviewed and revised the draft. All authors contributed to data result interpretation.

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Correspondence to Giacomo Cammarata.

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Cammarata, G., Altieri, R., Certo, F. et al. Post-traumatic intra-orbital meningoencephalocele in adults: technical note on a rare entity and review of the literature. Neurosurg Rev 46, 6 (2023). https://doi.org/10.1007/s10143-022-01906-0

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