Our concern is that the repair might break down, or that elevated intracranial pressure may cause a leak in another location,” he says. “Janie did really well with the surgery and in recovery. Citardi every six months in follow-up since her August 2017 surgery. Postoperatively, Lee had no sign of leakage. Patients who undergo CSF leak repair generally spend two days in the hospital and during recovery, maintain a low activity level for six weeks to aid healing. “Once we’ve found it, we seal it with multiple layers of graft material that act as a scaffold to set the body up so it can heal itself.” “The crucial element is identifying the location, which can be challenging,” he says. “In Janie’s case, we believe it was a delayed onset leak after prior sinus surgery.”Įndoscopic CSF leak repair is a delicate surgery. Citardi, who leads Texas Skull Base Physicians, which combines the expertise of otorhinolaryngologists and neurosurgeons at UTHealth. “The two most common are traumatic injury and elevated intracranial pressure,” says Dr. Citardi said we don’t need to move that quickly, and his calmness and the tranquil atmosphere of his office relaxed me.”ĬSF leaks have multiple causes. “Once I knew my runny nose was a CSF leak, I was ready to go NPO right away to prepare for surgery the next morning,” Lee says. Citardi, MD, professor and chair of the Department of Otorhinolaryngology-Head and Neck Surgery at McGovern Medical School at UTHealth. When she called her ENT in Lufkin, he referred her to Houston rhinologist and skull base surgeon Martin J. Today, CSF leaks are easily confirmed through detection of beta-2 transferrin, a protein present in CSF but not usually found in nasal secretions, blood, or other body fluids. While the glucose testing for a CSF leak is far from 100 percent reliable, it was often used years ago. “With the help of a coworker, I did a glucose meter test.” Lee’s 40 years of nursing experience led her to suspect it was cerebrospinal fluid (CSF). After a cruise that summer, I said, ‘Enough is enough!’ and started investigating.” “For six months I couldn’t go anywhere without it. “At spring break in 2017, I went to Disney World in Orlando and packed clothes with pockets so I could carry Kleenex,” she recalls. The liquid was so copious that she could squeeze fluid out of the tissue after taking her mask off. A nurse at Woodland Heights Medical Center in Lufkin, Texas, Lee stuffed tissue in her nostrils and put a mask on when she was called to see a patient. Clear fluid ran from her left nostril during the day and down her throat at night. For months, Janie Lee’s nose wouldn’t stop running.
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