BENGALURU: A 10-year-old boy from the Maldives, who was suffering from a persistent watery discharge from his nose and recurrent meningitis for nearly two years, was found to have a rare congenital defect in his skull that was causing cerebrospinal fluid (CSF) to leak through his nose.
The child had already undergone two surgeries outside India, but the leak kept recurring. CT, MRI, CT cisternography scans, along with a nasal endoscopy were made in Bengaluru to locate the source of the leak.
A congenital opening in the skull base known as the craniopharyngeal canal, which normally closes soon after birth, had remained open in the child. It was also hidden behind the adenoid tissue, making it difficult to detect. The previous surgeries had further altered the child’s nasal anatomy, making the repair more complicated. Doctors used navigation-assisted endoscopic surgery to locate the opening and seal it through the nose, without an external incision. A multilayer repair using tissue grafts, biological glue and a vascularised nasoseptal flap was used to close the defect.
Dr P Subramanya Rao, neck and skull base surgeon at Apollo Hospitals, Bannerghatta, said that the unusual location of the defect and the changes caused by the earlier surgeries made both diagnosis and treatment challenging. The CSF leak stopped immediately after the surgery and the child recovered without complications. He has now returned to school and his regular activities.