TRANSNASAL ENDOSCOPIC SURGERY - Dr. P. THULASI DAS
The brain floats in cerebrospinal fluid (CSF) which acts as a shock absorber. Sometimes this fluid comes out through the nose through a defect in the bone separating the nose and the brain, a condition called CSF rhinorrhoea.
The patients carry a risk of meningitis if the defect is not sealed. The neurosurgical procedure used hitherto to plug this defect involves cutting open the skull (craniotomy), lifting up the brain, searching for the defect and plugging it with fascia. This is a major procedure, associated with morbidity and recurrence rate.
Using Endoscopic techniques, the site of leak is located from the nose since the roof of the nose forms the floor of the brain and the leak can be plugged with cartilage and fascia. At Sinus and Nose, we have done over 200 endoscopic repairs of CSF fistulae in the last 15 years. Today our technique is pretty much standardised. For small defects we use temporalis fascia onlay. For defects larger than 4mm, we use cartilage inlay and temporalis fascia onlay. We have repaired defects up to 2cm with septal cartilage. 3 patients required a second procedure, of which one required a third procedure. None required intracranial neurosurgical intervention. The overall success rate is 100%. This procedure can be repeated without much fuss in case of recurrence.