Repairing Bone Defect in Nasal Cavity/Brain

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 a study published in the October 2004 issue of The Laryngoscope.

The condition, called cerebrospinal fluid rhinorrhea, results when trauma or high pressure inside the skull causes a break that allows a direct communication between the nose and the brain, potentially causing meningitis and even death. The alternative to endoscopic surgery is opening the skull, moving the front portion of the brain out of the way, destroying small nerves in the process, and approaching the defect from the top. This approach may be necessary if the defect is too big to treat endoscopically.

Dr. Stilianos E. Kountakis, vice chair of the department of otolaryngology head and neck surgery at the Medical College of Georgia (Augusta, USA; www.mcg.edu) and principal author of the study, suggests trying the endoscopic approach several times before resorting to the open procedure. The endoscopic approach employs small cameras and monitors so surgeons can operate with minimal trauma.

The study involved 92 patients, age six to 81, who had endoscopic repair of the condition. Of these, 92% had long-term success. The endoscopic approach was successful the first time in 85% of patients. Five patients with large defects eventually needed the open-skull procedure.

Unfortunately, prior endoscopic sinus surgery was the cause of the leak in 25% of patients. "It's a known risk of the operation,” explained Dr. Kountakis. "But if it happens during surgery, it should be repaired then.”




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Medical College of Georgia