Orbital roof fractures after blunt injury are rare. Traumatic encephaloceles in the
orbital cavity are even rarer, with only 15 cases published to date.
The clinical, radiological, and surgical findings of 6 cases of traumatic encephalocele
treated at our institution from June 1998 to January 2000 are presented. They are
also compared with previously published series.
In contrast to other published cases, 5 out of 6 patients in our series were adults.
The most common cause of trauma was road traffic accident. Ecchymosis and preoperative
exophthalmos/proptosis were frequent. In all of our patients a coronal CT scan (3
mm increments with bone windows) was obtained. It demonstrated the extension of the
orbital roof fractures and a possible encephalocele in 4 cases. Associated frontal
brain contusions were seen in 5 cases. An MRI was performed in 3 patients (and only
in 2 previously published cases); it showed the extension of the brain herniation
into the orbital cavity. Surgical treatment via a fronto-basal approach with evacuation
of the contused herniated brain tissue and orbital roof reconstruction was performed.
The outcome at 6 months was good recovery in five patients with one patient still
in a persistent vegetative state. Postoperatively the ocular disturbances improved
in 5 cases. A review of the other published cases confirmed recovery of normal ocular
function in the vast majority of the cases.
Whenever orbital roof fractures associated with frontal contusions are identified
in an acute brain injured patient, an orbital encephalocele should be suspected. In
our opinion MRI is the investigation of choice in such patients. If the encephalocele
is confirmed, a surgical approach via the subfrontal route is indicated with resection
of herniated contused brain tissue, dural closure, and orbital roof reconstruction.
Good results in regard to the orbital symptoms (mainly exophthalmos) can be expected.