The patient was operated by me 22-April-2010 for retrobulbar B-cell low grade lymphoma, during which decompression of the upper and lateral wall of the right orbit was performed.

The patient improved in all parameters, but CSF leak took place and did not resolve with conservative measures.

Considering that 13 days elapsed without stopping the CSF leak, the wound was opened only in the right half and the bone flap reflected to the right ear. Inspection of the source of the CSF leak revealed that, the very thin dura under the mediobasal frontal lobe was oozing from 2 points. Nylon 6 zero was used to stitch the tiny dural defects and artificial dura with gluebran was applied in all suspicious points of CSF leak.  The patient head was lowered and Valsalva maneuver was applied to check for CSF leak. It was negative. Routine closure of the wound.

Smooth postoperative recovery with no complications. and the patient was asked to set down and put his nose down. No CSF leak was noted as before surgery.

The patient  had previously very thin dura at the mediobasal surface of the frontal lobe which was dissected from the superior orbital roof. During the first surgery the patient was in Mannitol and Lazix for what the CSF leak was not noticed at the end of the surgery.

Usually the CSF leak disappear after 3-4 days after surgery, but the patient has allergic cough from the roses, which were brought by the family, which triggered the CSF leak.

Since 13 days elapsed after surgery, repair of the CSF leak source must be managed surgically to avoid future complications.