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This exhibit illustrates the first part of a craniotomy and mastoidectomy procedure to repair a cerebrospinal fluid (CSF) leak. First, an incision was made to expose the left temporal bone and mastoid process of the skull. A mastoidectomy was then performed with an operating drill, exposing an encephalocele and tegmen tympani fracture. Cautery was used to reduce the tegmen fracture and encephalocele. Attention was then brought to the temporal region, and a craniotomy flap was fashioned with drills. The flap was reflected and the dura was opened laterally with a scalpel. A lumbar drain was then placed, and 30ml of CSF was removed to reduce intracranial pressure.