The patient was operated by me 03-July-2013 for total removal of the benign hemagioblastoma of the right cerebellar hemisphere with insertion of Torkildsen shunt. The patient progressed paralytic ileus after this second operation and was treated conservatively. The patient returned to Yemen after 2 weeks and then started to complain of dizziness and headache with inability to walk and hypophonia the last weak in Yemen. By telephone communication, the son was advised to perform to him MRI of the brain, which was done three days ago, showing disappearance of the tumor, but having CSF huge pocket in the posterior neck outside the cranium, mainly in the right side.

On examination: the patient is stuporous but obeying command with delay, moving all limbs with hypophonia. There is huge CSF pocket in the posterior neck at the operative site. Na was 127 mEq/L.

The wound was opened and there was a tear near the lateral border of the lyodura graft. Using nylon 4 zero with muscle sheet taken from the neck muscles, water-tight closure of the dural defect was achieved. Layer by layer water-tight closure of the wound. The skin was closed by 3 zero nylon.

Smooth postoperative recovery. The patient was sent to the ward.

The patient had paralytic ileus after the previous surgery. This could trigger the arising of CSF pocket, which took place not from the grafted dura or the shunt place, instead it came from another point lateral to these places.