The patient was operated by me 01-November-2007 for remnant of the tumor . The patient was doing well and the wound was clean, until the third postoperative day after 2 days of ambulation, suddenly progressed CSF leak. The patient was put in Mannitol without help. The next day diamox was administered 4 times a day and the third day Lasix 40 mg twice daily with putting the patient in the head down position with strict bed rest, without results. Considering the huge amount of CSF leak with these measurements, it was decided to explore the wound.

Debridement of all the old scarous tissues was performed. and the dura was seen open at the middle of the field, about 7 mm length. The stitches at this defect were slipped. It was possible to see the spinal cord which regained a normal appearance running inside the dura with good pulsation of the xanthochromic CSF. The dura was closed tightly and check with elevation of the head and Valsalva maneuver, showed no CSF leak. For more security, a piece of muscle with histocryl glue was impacted over the the upper part of the dural incision. Tight layer by layer closure of the wound with water-tight closure of all layers.

Smooth postoperative recovery.

CSF leak is one of the usual complications after spinal or cranial surgeries.

Usually conservative treatment can resolve the problem in more than 70% of cases. If the CSF fail to show decline in its production and leak, it is better to explore the wound and close the defect. 4 Zero nylon was used and hermetic closure was achieved and further aid with muscle and glue were used for assurance of CSF leak closure.

The dural defect was 7 mm length and it was unlikely, that conservative measures will resolve the problem.

It was striking, that the spinal cord regained normal appearance in comparison to the previous surgery.