The CSF leak must be stopped to prevent further damage to the brain, whatever the cause.

The patient to the clinic 17-November-2002 complaining of CSF leak for 2 years. For 6 years had epi-attacks for what Tegretol was given and she was epi free for 2 years. The attacks returned the last 6 months. The CSF leak increased the last month. MRI done 07-November-2002 showing bony defect at the right frontal base in planum sphenoidal lateral to the olfactory groove. It is either meningocele of growing fracture over the years.

On examination: The patient has no meningism and the CSF leak came out when putting the face down. She is neurologically free.

Bifrontal skin incision with osteoplastic craniotomy over the right frontal area abutting the floor of the anterior fossa. During craniotomy the dura was torn at the anterior edge of the bone defect. Separation of the dura off the skull base of the frontal fossa. The dural defect identified and circumferentially dissected. Closure of the dura using periostium stitched to the dura. Intradural exploration showed gliotic brain tissue going down to the pervious defect. It was coagulated and bisected. Thee gap was filled with muscle. The opened dura was stitched by 6 zero nylon. Routine closure of the wound. Through the right nostril using trans-sphenoidal equipments, the parts in the right nostril was coagulated  and eliminated.

Smooth postoperative recovery. She was sent to the ward.

The patient came to the clinic 30-November-2002 with clean wound, no CSF leak complaining of numbness attacks all extremities? She was advised to keep n Tegretol CR 400 mg twice a day for 3 years and repeat MRI after 6 months, but she disappeared.