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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12-OCTOBER-2011 IBTISAM MUHSEN AL-HATABY 25
YEARS CSF LEAK AND MASSIVE ICH AND LACERATION OF LEFT TEMPORAL LOBE AFTER
patient was seen at the ICU 10-October-2011 2
days after performed ENT intervention to the
left ear. The patient was lethargic with
right sided paresis and plegia of the right
upper limb and dilated pupil left eye and
paralysis of the left oculomotor nerve and a
massive CSF leak coming from the external
examination: the patient has full dilated left
pupil with complete paralysis of the left
oculomotor nerve. Broca area is preserved, but
she has dense plegia of the upper limb and deep
paresis of the right side of the face and less
of the lower limb.
and CT-scan of the brain with DICOM were
requested and the investigations showed massive
ICH and infarction of the brainstem left side
and the crus cerebri with laceration of the left
temporal lobe with IVH of the left lateral
ventricle. Using ORSVisual the character
of the bone defect and the dural defect were
Left temporal approach was
performed and the dural defect was
circumferentially identified over the bone
defect. The internal temporal artery was
coagulated and cut, for further exposure of the
torn dura. Lacerotomy of the temporal lobe was
done until the normal brain matter was seen.
Using 30x20 mm lyodura, the dural defect was
water-tightly closed and another layer of
lyodura was used with glue over this layer to
aid more security to prevent possible CSF leak.
A piece of muscle was used to cover the inner
ear cavity, over what several pieces of bone
were used to cover the bone defect aided with
closure of the wound. Smooth postoperative
recovery with disappearance of the dilated
pupil and improvement of the power of the right
side of the body.
Please! wait for 3-5 min till the
video start to load. It depends upon the internet
The patient has huge dural and bone defect.
Conservative treatment is not considered in this
Lacerotomy is a powerful measure to reduce
arterial spasm and improve the neurological
Notice: Not all operative activities
can be recorded due to lack of time.
Notice: Head injuries and very urgent surgeries are also
escaped from the plan .