Rare Skull-Base Surgery Performed Without Incision at Venkateshwar Hospital, Saves Patient’s Life

• A team of doctors led by Dr J M Hans, Chairman Ent and Cochlear implant, Venkateshwar Hospital, New Delhi,performed this rare surgery

• The surgery helped heal a case of CSF rhinorrhea, the drainage of the fluid from the brain through the nose

When Pushpa Singh (name changed to protect identity) came to Venkateshwar Hospital 10 days ago, she had fluid draining out of her nose that seemed to resemble a cold. However, on close questioning, and on examination, Dr YatinSethi, senior consultant ENT surgeon at, Venkateshwar Hospital, Dwarka,New Delhi, inferred from his14+ years of experience. After a CT scan and MRI, the detection was what he had suspected: Singh had CSF rhinorrhea, or the drainage of cerebral spinal fluid from the nose.

“This usually takes place when the thin bone separating the brain from the sino-nasal cavity is not present. The absence of this protective barrier makes the brain bulge and leak, leaving the brain open for infections. The patient had meningitis (brain fever) a few years ago because of this, and this was an indicator for the condition. Usually, CSF rhinorrhea is caused by an accident or any traumatic episode. However, in the case of Singh, the cause was idiopathic (not known). Her age, at 68, the fact that she had diabetes, high blood pressure, and respiratory problems, all added to the complications,” says Dr YatinSethi.

Once the cause of the fluid drainage was confirmed, the team at Venkateshwar Hospital lost no time in admitting the patient, as CSF rhinorrhea is potentially life-threatening.Great care had to be taken while giving anesthesia, due to the patient’s history of a respiratory failure some years ago.

“The earlier technique of treating the condition was to cut open the skull and perform a surgery that would take upto 6 hours. Today, with the advancement of technology and skills in ENT endoscopic surgery, this procedure takes less than an hour, with no incisions. This eliminates pain and discomfort for the patient. Aside from a course of antibiotics, there is no other medication that is needed. This endoscopic surgery, performed with the bath-plug technique (literally plugging the leak with the help of its own fat)brings down the risk of infections. The patient is now doing well at home,” says Dr YatinSethi.

Under the leadership of J M Hans Chairman Ent and Cochlear implant, Venkateshwar Hospital, Dr Sethi who performs such advanced endoscopic ENT surgeries. He has undertaken special trainingduring a fellowship in Australia. This surgery is a pioneering procedure, not just for the hospital and for North India, but also for the advancement of ENT surgery itself, as going beyond the nose and sinuses, to venture into the brain. “Today, ENT surgeons have a wider scope of work than ever before, supporting neuro-surgeons and other doctors in the endeavour to provide the best possible diagnosis and surgical treatment to patients,” says Dr YatinSethi.