On October 1st I woke up with clear fluid poring out of my nose, seven weeks later I was diagnosed with a CSF leak when the fluid tested positive for glucose and CT scan showed a defect in the cribaform plate. I had surgery to pack the leak from the sinus side using cartilage from my nose and tissue from behind my ear at the same time a catheter was inserted in my spine to reduce the spinal fluid pressure. The packing and drain were left in place for 7 days, I spent 17 days in the hospital, 12 flat on my back. More than three months have past and I still have a slight trickle of clear fluid coming out of my nose, this has tested positive for glucose, yet an MRI shows no indication of a leak. I'm scheduled to have a lumbar puncture next week, the surgeon is going to inject dye in my spinal fluid to see if it come through the nose, if it does he has discussed doing a craniotomy to repair the leak from inside the skull. Is this the right next step to take? He told me the problem could lead to meningitis which could also heal the leak, would that be a better alternative? Is there another solution to repairing a CSF leak? I'd appreciate any advice on this subject.
Thank You.
Reply: --------------------------
The initial treatment you have described sounds very appropriate. If a
persistent leak is found on repeat CT scanning with intrathecal
contrast, there are really only 2 alternatives:
1) You could consider a repeat attempt to repair the leak from below
similar to the initial management you described. I would be inclined to
attempt to develop a vascularized flap of mucosal lining from the
turbinate or septum to rotate over the area of CSF leak. Then I would
pack the nasal passage as before and have a neurosurgeon place a lumbar
drain. I would then hospitalize you for a period of 5-7 days with
strict bedrest. After discharge minimal activity and no nose blowing
would be necessary for several weeks.
2) Proceed to a combined neurosurgical-otolaryngological approach which would involve a craniotomy
--
Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
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