Occult Fronto-Orbital Fracture Presenting as Traumatic Pseudomeningocele in a 4-Month-Old Infant: Successful Surgical Management in a Resource-Limited Setting

Abstract: Traumatic fronto-orbital pseudomeningocele is an exceptionally rare complication of paediatric head trauma and may be overlooked because of subtle or delayed radiological findings. It results from cerebrospinal fluid (CSF) leakage through a dural defect associated with skull fractures. We report the case of a four-month-old male infant who presented with progressive right frontal and supraorbital swelling ten days after a minor fall. Cranial computed tomography revealed an occult fracture of the right frontal bone extending into the superior orbital wall with a communicating CSF collection causing inferior displacement of the globe, consistent with traumatic fronto-orbital pseudomeningocele. The patient underwent right-sided craniotomy through a bicoronal approach, during which a dural tear was identified and primarily repaired, followed by secure repositioning of the bone flap. The postoperative course was uneventful, with complete resolution of swelling and restoration of normal ocular position. At the two-week follow-up the infant remained neurologically intact with no evidence of complications. This case highlights the importance of early radiological diagnosis and timely surgical management of rare fronto-orbital pseudomeningocele in infants and demonstrates that favourable outcomes can be achieved even in resource-limited healthcare settings through prompt, multidisciplinary intervention. Keywords: traumatic pseudomeningocele, orbital fracture, orbital roof fracture, paediatric cranial trauma, cerebrospinal fluid leak, Somalia