Endoscopic approach best for repairing bone defect between brain, nasal cavity

October 06, 2004

The best approach for repairing breaks in the thin bone that separates the brain from the nasal cavity is through the nasal cavity, according to an analysis of 92 patients who had this increasingly common approach to treating a fortunately rare problem.

"The intranasal endoscopic approach is the best way to treat a potentially very bad problem," says Dr. Stilianos E. Kountakis, vice chair of the Medical College of Georgia Department of Otolaryngology-Head and Neck Surgery and principal author of the study published in the October issue of The Laryngoscope.

The alternative is opening the skull, moving the front portion of the brain out of the way - destroying smell nerves in the process - and approaching the defect from the top, an approach that may be necessary if the defect is too big to treat endoscopically, Dr. Kountakis says.

However, Dr. Kountakis suggests trying the endoscopic approach - which uses small cameras and monitors so surgeons can operate with minimal trauma - several times before resorting to the open procedure.

The condition, called cerebrospinal fluid rhinorrhea, results when trauma or high pressures inside the skull cause a break that allows a direct communication between the nose and brain, potentially causing meningitis and even death.

When the cerebrospinal fluid escapes through the nose, loss of protective fluid around the brain can cause headaches as well as the uncontrollable dripping. "That is something that is classic," says Dr. Kountakis, who directs the MCG Georgia Sinus and Allergy Center. "People say when they go to church and bow their heads to pray, fluid runs out," he says, noting that any activity that tilts the head downward or increases internal pressure, from exercise to straining to use the bathroom, can cause dripping. "You cannot stop it," he says. "Mucous from the nose, you always are able to sniff back. But because this fluid has such a low viscosity, when it runs, it runs uncontrollably."

As bad as that may sound, Dr. Kountakis says the biggest concern is brain infection, seizures and even death that can result when nasal contents work their way into the brain. "It's not a major cause of meningitis, but 10 to 50 percent of the people who have a cerebrospinal fluid leak will get meningitis." A small portion of the brain also can move into the nasal cavity through breaks in the thin bone at the base of skull and between the eyeballs, he says.

The study looked at the results of 92 patients age 6-81 who had endoscopic repair of the condition over a 12-year period at the University of Virginia in Charlottesville where Dr. Kountakis was on faculty before he came to MCG in July 2003. 92 percent of patients had long-term success; the endoscopic approach was successful the first time in 85 percent of patients. Five patients who had large defects eventually needed the open-skull procedure.

Causes of cerebrospinal fluid rhinorrhea include head trauma, sinus surgery, neurosurgery, brain infections, increased intracranial pressure caused by obesity, and cosmetic surgery of the nose. Prior endoscopic sinus surgery was the cause of the leak in 25 percent of patients. "It's a known risk of the operation," Dr. Kountakis says, "But if it happens during surgery, it should be repaired then."

To visualize the defect, doctors use a contrast medium and computerized tomography and may need instruments to probe the area to identify the location of the tiniest leaks. They can use nasal mucosa, cartilage and abdominal fat to repair holes. Patients are hospitalized for several days and shouldn't exert themselves following surgery.
-end-


Medical College of Georgia at Augusta University

Related Brain Articles from Brightsurf:

Glioblastoma nanomedicine crosses into brain in mice, eradicates recurring brain cancer
A new synthetic protein nanoparticle capable of slipping past the nearly impermeable blood-brain barrier in mice could deliver cancer-killing drugs directly to malignant brain tumors, new research from the University of Michigan shows.

Children with asymptomatic brain bleeds as newborns show normal brain development at age 2
A study by UNC researchers finds that neurodevelopmental scores and gray matter volumes at age two years did not differ between children who had MRI-confirmed asymptomatic subdural hemorrhages when they were neonates, compared to children with no history of subdural hemorrhage.

New model of human brain 'conversations' could inform research on brain disease, cognition
A team of Indiana University neuroscientists has built a new model of human brain networks that sheds light on how the brain functions.

Human brain size gene triggers bigger brain in monkeys
Dresden and Japanese researchers show that a human-specific gene causes a larger neocortex in the common marmoset, a non-human primate.

Unique insight into development of the human brain: Model of the early embryonic brain
Stem cell researchers from the University of Copenhagen have designed a model of an early embryonic brain.

An optical brain-to-brain interface supports information exchange for locomotion control
Chinese researchers established an optical BtBI that supports rapid information transmission for precise locomotion control, thus providing a proof-of-principle demonstration of fast BtBI for real-time behavioral control.

Transplanting human nerve cells into a mouse brain reveals how they wire into brain circuits
A team of researchers led by Pierre Vanderhaeghen and Vincent Bonin (VIB-KU Leuven, Université libre de Bruxelles and NERF) showed how human nerve cells can develop at their own pace, and form highly precise connections with the surrounding mouse brain cells.

Brain scans reveal how the human brain compensates when one hemisphere is removed
Researchers studying six adults who had one of their brain hemispheres removed during childhood to reduce epileptic seizures found that the remaining half of the brain formed unusually strong connections between different functional brain networks, which potentially help the body to function as if the brain were intact.

Alcohol byproduct contributes to brain chemistry changes in specific brain regions
Study of mouse models provides clear implications for new targets to treat alcohol use disorder and fetal alcohol syndrome.

Scientists predict the areas of the brain to stimulate transitions between different brain states
Using a computer model of the brain, Gustavo Deco, director of the Center for Brain and Cognition, and Josephine Cruzat, a member of his team, together with a group of international collaborators, have developed an innovative method published in Proceedings of the National Academy of Sciences on Sept.

Read More: Brain News and Brain Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.