Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

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

07.10.2004


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.

Toni Baker | EurekAlert!
Further information:
http://www.mcg.edu

More articles from Studies and Analyses:

nachricht Reusable carbon nanotubes could be the water filter of the future, says RIT study
30.03.2017 | Rochester Institute of Technology

nachricht Pan-European study on “Smart Engineering”
30.03.2017 | IPH - Institut für Integrierte Produktion Hannover gGmbH

All articles from Studies and Analyses >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: A Challenging European Research Project to Develop New Tiny Microscopes

The Institute of Semiconductor Technology and the Institute of Physical and Theoretical Chemistry, both members of the Laboratory for Emerging Nanometrology (LENA), at Technische Universität Braunschweig are partners in a new European research project entitled ChipScope, which aims to develop a completely new and extremely small optical microscope capable of observing the interior of living cells in real time. A consortium of 7 partners from 5 countries will tackle this issue with very ambitious objectives during a four-year research program.

To demonstrate the usefulness of this new scientific tool, at the end of the project the developed chip-sized microscope will be used to observe in real-time...

Im Focus: Giant Magnetic Fields in the Universe

Astronomers from Bonn and Tautenburg in Thuringia (Germany) used the 100-m radio telescope at Effelsberg to observe several galaxy clusters. At the edges of these large accumulations of dark matter, stellar systems (galaxies), hot gas, and charged particles, they found magnetic fields that are exceptionally ordered over distances of many million light years. This makes them the most extended magnetic fields in the universe known so far.

The results will be published on March 22 in the journal „Astronomy & Astrophysics“.

Galaxy clusters are the largest gravitationally bound structures in the universe. With a typical extent of about 10 million light years, i.e. 100 times the...

Im Focus: Tracing down linear ubiquitination

Researchers at the Goethe University Frankfurt, together with partners from the University of Tübingen in Germany and Queen Mary University as well as Francis Crick Institute from London (UK) have developed a novel technology to decipher the secret ubiquitin code.

Ubiquitin is a small protein that can be linked to other cellular proteins, thereby controlling and modulating their functions. The attachment occurs in many...

Im Focus: Perovskite edges can be tuned for optoelectronic performance

Layered 2D material improves efficiency for solar cells and LEDs

In the eternal search for next generation high-efficiency solar cells and LEDs, scientists at Los Alamos National Laboratory and their partners are creating...

Im Focus: Polymer-coated silicon nanosheets as alternative to graphene: A perfect team for nanoelectronics

Silicon nanosheets are thin, two-dimensional layers with exceptional optoelectronic properties very similar to those of graphene. Albeit, the nanosheets are less stable. Now researchers at the Technical University of Munich (TUM) have, for the first time ever, produced a composite material combining silicon nanosheets and a polymer that is both UV-resistant and easy to process. This brings the scientists a significant step closer to industrial applications like flexible displays and photosensors.

Silicon nanosheets are thin, two-dimensional layers with exceptional optoelectronic properties very similar to those of graphene. Albeit, the nanosheets are...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

International Land Use Symposium ILUS 2017: Call for Abstracts and Registration open

20.03.2017 | Event News

CONNECT 2017: International congress on connective tissue

14.03.2017 | Event News

ICTM Conference: Turbine Construction between Big Data and Additive Manufacturing

07.03.2017 | Event News

 
Latest News

'On-off switch' brings researchers a step closer to potential HIV vaccine

30.03.2017 | Health and Medicine

Penn studies find promise for innovations in liquid biopsies

30.03.2017 | Health and Medicine

An LED-based device for imaging radiation induced skin damage

30.03.2017 | Medical Engineering

VideoLinks
B2B-VideoLinks
More VideoLinks >>>