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 Do microplastics harbour additional risks by colonization with harmful bacteria?
05.04.2018 | Leibniz-Institut für Ostseeforschung Warnemünde

nachricht Rutgers-led innovation could spur faster, cheaper, nano-based manufacturing
14.02.2018 | Rutgers University

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: Molecules Brilliantly Illuminated

Physicists at the Laboratory for Attosecond Physics, which is jointly run by Ludwig-Maximilians-Universität and the Max Planck Institute of Quantum Optics, have developed a high-power laser system that generates ultrashort pulses of light covering a large share of the mid-infrared spectrum. The researchers envisage a wide range of applications for the technology – in the early diagnosis of cancer, for instance.

Molecules are the building blocks of life. Like all other organisms, we are made of them. They control our biorhythm, and they can also reflect our state of...

Im Focus: Spider silk key to new bone-fixing composite

University of Connecticut researchers have created a biodegradable composite made of silk fibers that can be used to repair broken load-bearing bones without the complications sometimes presented by other materials.

Repairing major load-bearing bones such as those in the leg can be a long and uncomfortable process.

Im Focus: Writing and deleting magnets with lasers

Study published in the journal ACS Applied Materials & Interfaces is the outcome of an international effort that included teams from Dresden and Berlin in Germany, and the US.

Scientists at the Helmholtz-Zentrum Dresden-Rossendorf (HZDR) together with colleagues from the Helmholtz-Zentrum Berlin (HZB) and the University of Virginia...

Im Focus: Gamma-ray flashes from plasma filaments

Novel highly efficient and brilliant gamma-ray source: Based on model calculations, physicists of the Max PIanck Institute for Nuclear Physics in Heidelberg propose a novel method for an efficient high-brilliance gamma-ray source. A giant collimated gamma-ray pulse is generated from the interaction of a dense ultra-relativistic electron beam with a thin solid conductor. Energetic gamma-rays are copiously produced as the electron beam splits into filaments while propagating across the conductor. The resulting gamma-ray energy and flux enable novel experiments in nuclear and fundamental physics.

The typical wavelength of light interacting with an object of the microcosm scales with the size of this object. For atoms, this ranges from visible light to...

Im Focus: Basel researchers succeed in cultivating cartilage from stem cells

Stable joint cartilage can be produced from adult stem cells originating from bone marrow. This is made possible by inducing specific molecular processes occurring during embryonic cartilage formation, as researchers from the University and University Hospital of Basel report in the scientific journal PNAS.

Certain mesenchymal stem/stromal cells from the bone marrow of adults are considered extremely promising for skeletal tissue regeneration. These adult stem...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

VideoLinks
Industry & Economy
Event News

Invitation to the upcoming "Current Topics in Bioinformatics: Big Data in Genomics and Medicine"

13.04.2018 | Event News

Unique scope of UV LED technologies and applications presented in Berlin: ICULTA-2018

12.04.2018 | Event News

IWOLIA: A conference bringing together German Industrie 4.0 and French Industrie du Futur

09.04.2018 | Event News

 
Latest News

Structured light and nanomaterials open new ways to tailor light at the nanoscale

23.04.2018 | Physics and Astronomy

On the shape of the 'petal' for the dissipation curve

23.04.2018 | Physics and Astronomy

Clean and Efficient – Fraunhofer ISE Presents Hydrogen Technologies at the HANNOVER MESSE 2018

23.04.2018 | Trade Fair News

VideoLinks
Science & Research
Overview of more VideoLinks >>>