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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19-MAY-2010 MUHAMED HUSSEIN FARJEN 50 YEARS
POST-TRAUMATIC CSF LEAK FROM THE THE ETHMOID BONY DEFECT LEFT SIDE.
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to the clinic 17-May-2010 complaining of massive
CSF leak from the left nostril for 2 months with
failed conservative treatment. The patient
suffered blunt injury to the forehead three
months ago with direct injury to the forehead.
CT-scan of the brain with frontal and axial cuts
with bone window thin cuts performed
24-April-2010 showing filling of the ethmoid
sinus in the left side with small bony defect 10
mm lateral to the crista Galli with fluid
filling the ethmoid sinus under the bony defect
and down to the left maxillary sinus.
On examination the
patient is neurologically free with preservation
Bifrontal skin flap
was created and reflected to the nose. Using 2
small burr holes a bony flap was was created
symmetrical to the midline , violating during
that the frontal sinus. Careful extradural
dissection of the left orbital roof. The crista
Galli was seen and the ethmoidal bony defect was
identified with the dural defect was also seen.
There was only one bony defect 4X4 mm rounded in
shape with smooth edges. The dura near the
olfactory bulb was not violated to avoid
traction injury to the olfactory bulb. A small
piece of muscle was impacted to the bony defect
in hourglass shape. The dural defects were
repaired using Nylon 6 zero. Using artificial
dura and Glubran the bony and dural defects were
also sealed to provide more security, so as not
to miss micro defects.
Routine closure of
Smooth postoperative recovery with no CSF leak
coming from the nose.
The ethmoid sinuses are tiny
bony structures and minor injury can cause
fractures of these bones. Growing fracture of
the bone could be the detrimental factor in the
appearance of such complication.
In no way this repair can be
achieved through trans-nasal approach. Only
subfrontal approach can give the confidence of
identifying and taking the appropriate measures
to prevent CSF leak.
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 .