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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11-JUNE-2013 MAJDI SHAWQI AL-BAYRUTI
33 YEARS CSF LEAK FROM THE RIGHT DEFORMED SUBSTANCIA CRIBROSA.
The patient came
to the clinic 21-April-2013 complaining of CSF
leak from the right nostril for 1 month, which
stopped the last week. The patient had right
otitis media 2 years ago and was treated
accordingly then underwent
surgical correction for septal deviation 12
MRI of the brain done 11-April-2013 showing
massive sinusitis with polyps of both maxillary
sinuses with deformity of the right olfactory
groove and disappearance of the right substacia
cribrosa and CSF pocket extending down to the
nasal septum right side. CT-scan also showing
the wide bone defect at the mentioned area.
On examination: The patient has anosmia both
sides. No meningeal signs. Otherwise
Bifrontal approach with
reflection of the bone flap to the right ear.
The dura was opened parallel to the inferior
border of the craniotomy. The dura was dissected
around the huge bone defect in the area of the
right olfactory bulb and planum
sphenoidale. The brain substance was extruding
to the bone defect, for what resection of the
herniated material was coagulated and bisected.
The dural defect was identified at the bony
defect site and using Lyodura, the dural defect
was water-tightly closed. sometimes intradural
and other time extradural. A small bone
harvested from the cranium was used to fill the
bone defect. A piece of muscle was used over the
bone graft. and Surgicele was put under the
Routine closure of the wound.
Smooth postoperative recovery.
The patient sent to the ICU for 24 hour
The patient was discharged in 14-June-2013 and
he progressed at home tonic-clonic convulsion
with secondary generalization with a direct
trauma to the craniotomy site. He was admitted
to Shmaisani hospital and CT-scan of the brain
was done immediately showed normal brain
structures and the bony alignments are
acceptable. Daily evacuation of bloody exudate
about 40 ml was evacuated from under the flap
and he was discharged 21-June-2013 to keep in
Tegretol CR 400 twice daily and Epanutin 100 mg
three times a day.
The cause of the CSF leak is mostly a growing
fracture of the substacia cribrosa after
performed septal deviation correction. The bone
at this area is very thin and minimal trauma
cold lead to fracture.
The bone defect is large enough, that it can be
sealed only by surgical means.
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