February 28, 2018

Video of Surgery to Stop Brain Fluid from Leaking Out the Nose

A new video has been uploaded demonstrating the surgical technique of stopping brain fluid (aka, CSF leak) from coming out the nose. Normally, there should be no hole that communicates between the brain and the nose. However, in some patients, this hole may be present secondary to sinus surgery, head trauma, or simply bad luck.

In essence, the steps to plug up this abnormal hole are as follows:

1) Fluorescein injected into the spinal fluid before surgery. Fluorescein makes the brain fluid bright green rather than the normal clear and transparent appearance making it much easier to locate the hole. (Picture #1 below)
2) Identify the exact location of the hole.
3) Clear away mucosal tissue around the hole and if necessary, make it slightly larger to make it easier to plug the hole.
4) Fat harvested from the earlobe is than stuffed up through the opening of the hole thereby plugging it. (Picture #2 below)
5) Nasal mucosa is than applied over the area to help seal it as it heals.

That's it!

The surgeon who performed the procedure in the video was Dr. Philip Chen, Assistant Professor at UT Health Science Center San Antonio.

Please note that although our office can certainly help diagnose a CSF leak from the nose (or ear), surgical correction will typically require a referral to a tertiary care center.

Picture #1: Hole where CSF leak identified

Picture #2: Fat plug being used to occlude the hole where
the CSF leak is happening.

Fauquier blog
Fauquier ENT

Dr. Christopher Chang is a private practice otolaryngology, head & neck surgeon specializing in the treatment of problems related to the ear, nose, and throat. Located in Warrenton, VA about 45 minutes west of Washington DC, he also provides inhalant allergy testing/treatment, hearing tests, and dispenses hearing aids.

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