The patient came to the clinic 24-March-2003 with parent telling that he suffered RTA 24-April-2002, he lost bone in the left occipital area and he underwent several surgeries. Skin graft was applied in May-2002 and bone cement was applied to close the bone defect. There was CSF leak from the parieto-occipital area 3 cm behind above the left ear.

On examination, the patient is neurologically free with CSF coming from the mentioned area. Conservative measures failed and the parents told me to resolve his problem.

Curve-linear incision in the left occipito-parietal area and the the bone cement was removed and all dirt from the accident and the granulation tissues were remove and inspection for the CSF leak was negative, because it could be closed by using the coagulation during granulation tissues removal. Routine closure of the wound. Smooth postoperative recovery.

The patient came to the clinic 02-May-2004 with clean wound and the parents to come after 6 months for reevaluation.

The patient then came 06-October-2004 with clean wound and the bone defect started to shrink in size with bone formation.

The patient then came 19-March-2005  with the same bone defect 2X2 cm and the parents were assured that it is not important and with time will disappear.

The patient then came 08-July-2007 telling that he felt down 45 min ago without loss of consciousness. Neurologically he was free and brain CT-scan showed closure of the bone defect with thin layer of bone.

RTA having a lot of problems, among them the legal part, for what I am trying to avoid treating them. But during the previous 30 years I have a wide experience with head injuries, that I am fed with these situations.