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15-SEPTEMBER-2008  ISSA AL-HAJ HASAN AYOUB  57 YEARS  CSF LEAK FROM THE CRANIOTOMY SITE PERFORMED 14 DAYS AGO.

Anamnesis:

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The patient was operated by me 01-September-2008 for recurrent glioblastoma multiforme with partial resection and gliadel application.

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MRI performed 10-September-2008 showed almost total resection of the right side with slight shrinkage of the contralateral side of the tumor at the right sylvian cistern.

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The patient was showing slow improvement, but the CSF start to leak the 4th postoperative day and persisted all the time despite the conservative measures.

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Considering that the patient underwent radiotherapy and Gliadel wafer installation 10 months ago, the first surgery was done so as to avoid the progression of CSF leak and wound dehiscence.

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The lower half of the old skin incision was refreshed and the 2 pieces of bone were seen to migrate downward. Their previous attachment  was lost. The dura had 5 defects and the major one was 10 mm in diameter at the center of bone defect. The tachsil which was applied at the last operation completely disappeared. 10 ml of orange color CSF was taken for CXS and cytological studies.

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Lyodura adapted to fulfill the bone defect was used and using Glubran-2 was used to make prompt water-tight closure of the dura. The 2 bone pieces also were fixed by Glubran-2. The muscle was stitched and the skin was closed with metallic clips.

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Smooth postoperative recovery.

Comments

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The patient in the last surgery was operated in a way, that if any possible complication of wound dehiscence or CSF leak, to prevent them and to avoid major catastrophic events.

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Despite these measures the patient progressed CSF leak. It was because we used Tachsil in the first operation. The finding that this material was completely lost within 14 days and the dural tears were seen at the previous stitches, because of Gliadel wafers, it is preferable in the future avoid using these materials, which depend upon the regenerative and clotting factors of the human body.

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