Deadly Brain Drain: Fixing a Leaky Skull

Sinus infections and allergies affect more than 31-million Americans every year. One woman thought her non-stop running nose was a symptom of that, but it was something far more serious.

When a clear fluid began to drip from Aundrea Aragon's nose, her doctor suspected it was a bad allergy.

But, the fluid wouldn't stop pouring out. It got so bad she was going through at least three rolls of paper towel a week.

"I was choking on the fluid at night, so it kept waking me up," said Aundrea Aragon who has a leaky skull.

Then after six months a new diagnosis, a tiny crack in her skull was allowing brain fluid to pour out.

"Her left sinus space is full of fluid,” explains Dr. Michael Lemole Professor & Chief of Neurosurgery at the University of Arizona. “You can see that fluid level right there. Those bacteria living in your nose can crawl up in the brain and basically cause a fatal infection."

Doctor Micheal Lemole helped fix Aundrea's leak with a unique endoscopic operation. Instead of opening up her skull he went up her nose.

"We can plug it from below and we don't have to subject the brain to that trauma," says Dr. Lemole.

Surgeons used neuro-navigation to find the crack. They took tissue from Aundrea's nose and belly to seal the leak.

"She is very lucky not to have gotten meningitis," says Dr. Lemole.

Now, Aundrea can focus on what matters. The endoscopic procedure is effective in 95 to 99 percent of selected cases.

Doctors are monitoring Aundrea's case, but say her prognosis is excellent.

MEDICAL BREAKTHROUGHS
RESEARCH SUMMARY

TOPIC: Deadly Brain Drain: Fixing a Leaky Skull
REPORT: MB # 3615

BACKGROUND: When the fluid which normally surrounds the brain begins to drip from the nose, it is referred to as a CSF leak. CSF stands for cerebrospinal fluid and is colorless, clear, and devoid of cells. CSF leaks occur when the brain lining and the bone separating the brain and the sinuses have been disturbed in some way. These kinds of leaks are often mistaken for sinus infections or allergy symptoms and so many patients go untreated. Unfortunately, since the barrier between the sinuses is compromised, these patients are at a high risk of infection, particularly meningitis. (Source: http://care.american-rhinologic.org/csf_leaks)

TYPES: While CSF leaks can result from accidental or surgical trauma where an injury causes cracks in the skull base or along the bone separating the brain and the sinuses, two other types of CSF leaks exist.

* Tumor-Related CSF Rhinorrhea: if an aggressive tumor or cancer invades the skull base, it can begin to erode the bone causing the barriers between the brain and sinuses to breakdown. The tumor then acts as the barrier and once removed, the patient begins to leak CSF.
* Spontaneous CSF Rhinorrhea: when none of the other causes have occurred, the CSF leak is considered to be spontaneous. There is some evidence suggesting elevated intracranial pressure could be responsible for these leaks, but the exact cause is still unknown. (Source: http://care.american-rhinologic.org/csf_leaks)

SYMPTOMS: It can be difficult to identify a CSF leak, but common signs of a leak include:

* Clear, watery drainage usually from one side of the nose or one ear that increases when the head is tilted forward or strained.
* Headaches, possibly accompanied by vision changes.
* Unexplained hearing loss. (Source: www.clevelandclinic.org)

NEW TECHNOLOGY: An endoscopic operation has become standard care for repairing CSF rhinorrhea because of its high success rate and low morbidity. Before the operation CT scans or MRI are taken to identify the area where fluid is leaking from. Then instruments are inserted into one of the nostrils. Sometimes fluorescein is injected so the defect becomes more visible under a certain filter of light. Once the defect is found, surgeons strip away the mucosa and graft material is placed to patch the injury. The material used for the graft can come from various places such as cartilage or abdominal fat, but generally where the graft material comes from has no bearing on the success of the operation. (Source: www.utmb.edu)

FOR MORE INFORMATION, PLEASE CONTACT:

Jo Marie Gellerman
Director of Marketing and Community Affairs
Department of Surgery
The University of Arizona College of Medicine
(520) 626-7219
jgellerm@email.arizona.edu

If this story or any other Ivanhoe story has impacted your life or prompted you or someone you know to seek or change treatments, please let us know by contacting Andrew McIntosh at amcintosh@ivanhoe.com.


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