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.

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Contact: Toni Baker
tbaker@mcg.edu
706-721-4421
Medical College of Georgia
6-Oct-2004