Mumbai

Doctor plugs brain fluid leak through patient’s nose

ENT surgeon uses biological glue to repair leakage

A piece of bone from the nose, skin from the leg and a biological glue helped doctors repair the leakage of brain fluid in a 20-year-old Kurla resident. Mohammad Arfad Khan had suffered a skull fracture after a fall when he was 10 years old. While the fracture healed over the years, the damaged bone gave way a few months ago and he began experiencing a watery discharge from his nose.

Mr. Khan’s case was diagnosed as a cerebrospinal fluid (CSF) rhinorrhea, a condition wherein the brain’s protective fluid leaks into the nose and sinuses. Mr. Khan recalls experiencing the discharge since July last year, which he and his family members ignored as an attack of common cold.

When he also began getting headaches, they sought medical help and a consultation with a neurology expert confirmed that cerebrospinal fluid was leaking through the fractured skull bone. “When he had the fall as a child, he had experienced fluid coming through his nose but that had stopped within a few days,” said Mr. Khan’s brother Mohammad Aftab.

Many neurosurgeons Mr. Khan consulted suggested surgery by opening the skull. However, Dr. Sanjay Helale, an ENT surgeon from Kohinoor Hospital, said he could repair the defect through the nose. “We took help of a navigation device to guide us to the point of damage through the nose and carried out the repair with the help of an endoscope,” said Dr. Helale. The two-and-a-half-hour procedure was challenging because the site of the defect was difficult to access. Dr. Helale said the procedure involved borrowing skin from the patient’s leg to plug the defect in the membrane and then taking a 2x2 cm bone from the nose to close the skull defect.

“We used biological glue to hold it all together. During the procedure, we increased the brain pressure to check if our repair remained intact,” said Dr. Helale.

A neurosurgeon was kept on standby. While the surgery was carried out on December 31, Mr. Khan remained at home to recover and avoid pollution that could cause complications. Since last week, he has been driving and helping out with his family’s steel business.

Dr. Helale is preparing to present the case in an ENT conference next month.

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Printable version | Apr 1, 2020 3:13:25 PM | https://www.thehindu.com/news/cities/mumbai/doctor-plugs-brain-fluid-leak-through-patients-nose/article30898910.ece

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