Under general anesthesia, a partial craniectomy to remove the external table of the involved calvarium was performed using an oscillating saw. Upon bone extraction, it was noted that tumor compromised the integrity of the inner table. Thus, its removal caused a tear and leakage of cerebral spinal fluid (CSF), although there was no evidence of injury to the brain. Immediately after the tear and leakage, the patient developed profound brady-cardia, with a heart rate in the low 30 beats per minute. This resolved with prompt closure of the dura using nylon sutures. A prosthetic plate was then placed over the area, and closure was pursued.
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