Most of the site will reflect the ongoing surgical activity of Prof. Munir Elias MD., PhD. with brief slides and weekly activity. For reference to the academic and theoretical part, you are welcome to visit
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15-SEPTEMBER-2008 ISSA AL-HAJ HASAN AYOUB 57 YEARS
CSF LEAK FROM THE CRANIOTOMY SITE PERFORMED 14 DAYS AGO.
The patient was operated by
01-September-2008 for recurrent glioblastoma
multiforme with partial resection and gliadel
10-September-2008 showed almost total resection
of the right side with slight shrinkage of the
contralateral side of the tumor at the right
The patient was showing slow
improvement, but the CSF start to leak the 4th
postoperative day and persisted all the time
despite the conservative measures.
Considering that the patient
underwent radiotherapy and Gliadel wafer
installation 10 months ago, the first surgery
was done so as to avoid the progression of CSF
leak and wound dehiscence.
The lower half of the old
skin incision was refreshed and the 2 pieces of
bone were seen to migrate downward. Their
previous attachment was lost. The dura had
5 defects and the major one was 10 mm in
diameter at the center of bone defect. The
tachsil which was applied at the last operation
completely disappeared. 10 ml of orange color
CSF was taken for CXS and cytological studies.
Lyodura adapted to fulfill
the bone defect was used and using Glubran-2 was
used to make prompt water-tight closure of the
dura. The 2 bone pieces also were fixed by
Glubran-2. The muscle was stitched and the skin
was closed with metallic clips.
Smooth postoperative recovery.
The patient in the last
surgery was operated in a way, that if any
possible complication of wound dehiscence or CSF
leak, to prevent them and to avoid major
Despite these measures the
patient progressed CSF leak. It was because we
used Tachsil in the first operation. The finding
that this material was completely lost within 14
days and the dural tears were seen at the
previous stitches, because of Gliadel wafers, it
is preferable in the future avoid using these
materials, which depend upon the regenerative
and clotting factors of the human body.
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Notice: Not all operative activities
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Notice: Head injuries and very urgent surgeries are also
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