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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08-AUGUST-2013 ALI YAHIYA AL-QUFAILY 64 YEARS
CSF POCKET AFTER POSTERIOR APPROACH.
The patient was operated by me
for total removal of the benign hemagioblastoma
of the right cerebellar hemisphere with
insertion of Torkildsen shunt. The patient
progressed paralytic ileus after this second
operation and was treated conservatively. The
patient returned to Yemen after 2 weeks and then
started to complain of dizziness and headache
with inability to walk and hypophonia the last
weak in Yemen. By telephone communication, the
son was advised to perform to him MRI of the
brain, which was done three days ago, showing
disappearance of the tumor, but having CSF huge
pocket in the posterior neck outside the
cranium, mainly in the right side.
On examination: the patient
is stuporous but obeying command with delay,
moving all limbs with hypophonia. There is huge
CSF pocket in the posterior neck at the
operative site. Na was 127 mEq/L.
The wound was opened and
there was a tear near the lateral border of the
lyodura graft. Using nylon 4 zero with muscle
sheet taken from the neck muscles, water-tight
closure of the dural defect was achieved. Layer
by layer water-tight closure of the wound. The
skin was closed by 3 zero nylon.
recovery. The patient was sent to the ward.
The dural defect is lateral to the graft and shunt
The patient had paralytic ileus after the
previous surgery. This could trigger the arising
of CSF pocket, which took place not from the
grafted dura or the shunt place, instead it came
from another point lateral to these places.
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