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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27-JULY-2011 MURAD NABEEL ABU-AFIFEH 26 YEARS
POST-TRAUMATIC CSF LEAK FROM THE FRONTAL SINUS AND SUBSTANSTIA CREBROSA WITH
CHRONIC SUBDURAL HEMATOMA RIGHT FRONTAL LOBE.
patient came to the clinic 24-July-2011
complaining of persistent CSF leak from the
nose, 6 weeks after RTA 25-May-2011 with which
had had loss of consciousness for one day and
underwent surgery for nasal bone fracture and
left foreleg fracture.
brain and MRI
brain done 16-July-2011 showing fracture of the
frontal sinus with CSF leak from the fracture
sites. There is subdural hygroma right frontal
examination: the patient has bilateral anosmia.
He claim that he has blurred vision right eye.
There is no meningism, nor fever. The patient
had mild left sided paresis. The patient was
put with the nose down, the CSF immediately came
Bifrontal incision was done
behind the hair line and reflected to the face.
The bone flap reflected to the left ear. The
chronic subdural hematoma was evacuated
from the right frontal area and meticulous
irrigation was performed. The dural incision was
closed water-tightly. Dissection of the dura
from the base of the frontal bone. There are
three bony defects one behind the olfactory bulb
right side and one extending from
symmetrical point reaching the planum
sphenoidale. The third was near the
fractured crista Galii. All the dural
tears and defects were water-tightly closed
using 4 zero nylon and the dura after repair was
aided with lyodura with glue. The bony defects
to the ethmoid cavities were filled with muscle
and glue. Ready vac drain was inserted to the
extradural space and the bone was reflected
closure of the wound. Smooth postoperative
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Anosmia is very common in head injuries, it
could happen in 10% of severe head injuries, but
here due to direct trauma to the region, the
anosmia must take place in 100% of cases due to
tiny structure of the fillia olfactoria.
The bone defects are wide, and only surgical
repair could resolve the problem.
The chronic subdural hematoma usually take place
in old patients, but here he is an exception.
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 .