For more than four months, Aundrea Aragon struggled with what doctors told her were allergies. Whenever she bent over, clear liquid – which turned out to be brain fluid – streamed out her nose.
It took several trips to different doctors before the cause of the leaking fluid was determined. Two small cracks in the back wall of Aragon’s sphenoid sinus allowed cerebral spinal fluid (CSF) to leak.
Most often, surgeons repair such cracks, which are caused by cerebral pressure, through craniotomies, resulting in painful recoveries, extensive scarring and possible side effects.
But a team of UAsurgeons were able to fix Aragon’s leaks with an endoscopic procedure through the nose, requiring no incisions on her head and resulting in a shorter hospital stay and faster recovery.
Alexander G. Chiu, MD, chief of the Division of Otolaryngology, and G. Michael Lemole, MD, chief of the Division of Neurosurgery, in the UA Department of Surgery, used image-guided neuronavigation and fluorescein dye to help find the cracks. They then used tissue from inside Aragon’s nose, as well as a small piece of belly fat, to repair the cracks and stop the leak.
“This case is a nice example where the otolaryngology and neurosurgery team approach really helps,’’ Dr. Chiu said.
“Our ability to refine our technique and our synergy with one another allowed for our patient to go home sooner,’’ Dr. Lemole said.
Aragon was referred to Drs. Chiu and Lemole from a community otolaryngologist based on their national reputation in skull-base and minimally invasive surgery. The two pair up to perform as many as 80 sinonasal and skull-base cases a year, commonly treating tumors of the sinuses and skull base, head trauma and CSF leaks in patients from throughout Arizona and neighboring states.
“This type of interdisciplinary teamwork has resulted in UAMC becoming a referral center for the best surgical treatment options for patients with complex neurological and otolaryngological disorders,” said Rainer W.G. Gruessner, MD, chairman, UA Department of Surgery.
Before her diagnosis, Aragon said she was terrified she might not survive.
“I was scared to death and desperate,’’ Aragon said. “I knew it could not be allergies. The fluid would come out like a puddle.’’
Steroids and antibiotics did nothing. “I was walking around with toilet paper shoved up my nose and changing it every 10 minutes,’’ she recalled.
Aragon and her husband, Anthony, said they knew they were in good hands with Drs. Chiu and Lemole.
“They were very patient and answered all of our questions,’’ Anthony Aragon said. Both were relieved that minimally invasive surgery could be performed, accessing the cracks through Aragon’s nasal cavity.
They also were relieved to hear the statistics: Performed endoscopically, the procedure is successful in 95 to 99 percent of cases; it is only 60 percent successful when performed via craniotomy, Dr. Chiu said.
While the human body replaces brain fluid, Aragon was at risk for developing a lethal infection.
“If you are leaking brain fluid out your nose then you have the potential for catastrophic meningitis, the kind where bacteria crawls into your brain and 24 hours later you are essentially in a coma or dead,’’ Dr. Lemole said. “That is what we worry about in these cases.”
Aragon is recovering well, and is happy to be home with her husband and children – Art, 16, Marc, 10, and Reina, 9.
Aragon posted about the success of her Oct. 1 surgery recently on Facebook.
“I am so grateful to them for everything they have done for us,’’ said Aragon. “I had great care from a great staff,” she said. “I’m here, and I am grateful I can take care of my kids.”