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.
Toni Baker | EurekAlert!
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