Cerebrospinal fluid oculorrhea: A rare complication after orbital exenteration for cavernous sinus meningioma with orbital extension and radiation-induced hydrocephalus.

Background: Cavernous sinus meningiomas are rare, and radiotherapy is considered because the risk of postoperative complications is high. Radiotherapy is useful for short-term control of meningiomas, but hydrocephalus may appear as a long-term complication.

Case description: A 71-year-old male patient suffered from a cavernous sinus meningioma with orbital involvement and communicating hydrocephalus. Radiotherapy was administered thrice due to tumor progression. Right intraorbital meningioma increased markedly, and right eye bulging and visual deterioration were aggravating. Tumor removal with orbital exenteration was performed to prevent left visual impairment due to tumor progression. The pathology was atypical meningioma (WHO grade 2). Postoperative cerebrospinal fluid (CSF) leakage from the right orbit, so-called oculorrhea, was difficult to repair due to hydrocephalus, requiring eyelid sutures and a lumboperitoneal shunt. The tumor never developed into the opposite cavernous sinus.

Conclusion: Radiation-induced hydrocephalus can lead to intractable postoperative CSF leakage from orbit after tumor removal with orbital exenteration and require surgery. In these cases, hydrocephalus treatment may lead to a cure for intractable CSF oculorrhea.