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05-MAY-2010 HUSSEIN ABDEL-FATAH HAMDAN PERSISTENT
CSF LEAK AFTER CRANIOTOMY FOR RETROBULBAR MASS RIGHT EYE 13 DAYS
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operated by me
22-April-2010 for retrobulbar B-cell low
grade lymphoma, during which decompression of
the upper and lateral wall of the right orbit
The patient improved
in all parameters, but CSF leak took place and
did not resolve with conservative measures.
Considering that 13
days elapsed without stopping the CSF leak, the
wound was opened only in the right half and the
bone flap reflected to the right ear. Inspection
of the source of the CSF leak revealed that, the
very thin dura under the mediobasal frontal lobe
was oozing from 2 points. Nylon 6 zero was used
to stitch the tiny dural defects and artificial
dura with gluebran was applied in all suspicious
points of CSF leak. The patient head was
lowered and Valsalva maneuver was applied to
check for CSF leak. It was negative. Routine
closure of the wound.
Smooth postoperative recovery with no
complications. and the patient was asked to set
down and put his nose down. No CSF leak was
noted as before surgery.
The patient had
previously very thin dura at the mediobasal
surface of the frontal lobe which was dissected
from the superior orbital roof. During the first
surgery the patient was in Mannitol and Lazix
for what the CSF leak was not noticed at the end
of the surgery.
Usually the CSF leak
disappear after 3-4 days after surgery, but the
patient has allergic cough from the roses, which
were brought by the family, which triggered the
Since 13 days elapsed after
surgery, repair of the CSF leak source must be
managed surgically to avoid future
Notice: Not all operative activities
can be recorded due to lack of time.
Notice: Head injuries and very urgent surgeries are also
escaped from the plan .