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Dr Uzair
Dr Uzair, Doctor
Category: Neurology
Satisfied Customers: 6178
Experience:  MBBS, FCPS (R) General Surgery, 5 years experience in Emergency Medicine.
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Back in September 2015, I had surgery to remove a cancer

Customer Question

Back in September 2015, I had surgery to remove a cancer from inside my left nostril. Two weeks later, I had another surgery to remove more cancer. Then I had to have my nose reconstructed, have had a procedure to check for a fungal infection in the surgery site and later had another procedure to clean out impacted sinuses. My nose is sill not healed completely. The left nostril is still swollen and tender inside. My nose runs a lot, a clear fluid that I assumed was sinus drainage. Recently, the surgeon's assistant mentioned brain fluid drainage and acted very concerned. Since the drainage has continued over a period of several weeks,. I am now getting concerned and wondering if this brain fluid drainage could be happening.
My body has been subjected to a lot in the last couple of years. During a regular annual check-up, it was discovered that I had had a small stroke; I had surgery to remove a serious build up of plaque in the carotid artery. A stent was inserted. I also started having some sort of seizures. I would black out, be unable to move, could not speak. I was hospitalized at least 3 times for that. This went on over a period of one year. I was in a fairly serious car accident in September 2014 and suffered a cracked rib and multiple hematomas in the chest and stomach area from the seat belt. Then came the cancer surgery and a 5-day-a-week, 6 week period of radiation treatments. I tire easily and often am dizzy/lightheaded and once passed out in my kitchen for a short period of time.
I am diabetic but my primary care physician is satisfied with my A1C. It is checked every 3 moths.
Oh, I just turned 75 years old and until I turned 60 was in good health. After 60, I started falling apart. The important ailment was a quadruple bypass performed in 2003. I have a cardiac work up each year.
All the extra information may not be important or a contributing factor to my primary concern about brain fluid leakage but, then again, maybe the medical history will help. Regardless of all that has transpired the last 15 years, I still consider myself to be in decent health. BUT, I keep getting hit with things about which I know nothing and I don't like being ignorant of my own state of being. The surgeon (usually an assistant) and my primary care doctor (usually an assistant) are not very forthcoming with information nor are they good about answering my questions. It's my life, my body and I need to know what is going on with it. Can you give me any information about the brain fluid leakage or point me in the right direction to find out what I might possibly be facing next?
I do thank you for any help and/or information you may give me.
Susan *******
**********@********.***
Submitted: 6 months ago.
Category: Neurology
Expert:  Dr Uzair replied 6 months ago.

Hi and thanks for the query, Susan.

CSF (Cerebrospinal fluid) aka brain fluid leakage can occur after a nasal reconstruction especially one which followed cancer extirpation. This is not a grave complication however, needs to be fixed as CSF leakage can cause headaches and vertigo and neurological symptoms. It depends on the amount of fluid leaking from the cribriform plate area.

This complication occurs when the cribriform plate (a thin bone wall that divides the nose from the frontal area of the brain) gets damaged during surgery.
Small holes in the wall can seal themselves over a course of 3 to 6 months. However, larger holes or more persistent leakage causes the hole to become permanent.

The solution is surgical. The galeal (fascia in the scalp) flap can be used to plug in the hole and that fixes the problem. The surgery is not a very long one but is done by a Neurosurgeon or a Plastic surgeon under general anesthesia. About 2 days post operative sat y is required in the hospital. A Lumbar puncture is often done at the time of surgery or after it to relieve any extra pressure of the CSF in the brain so that there is no pressure on the patch of fascia used to plug the hole.

However, before all this is done, a visit to the Neurosurgeon is warranted. The clear fluid leaking from the nose needs to be sent for an analysis.

This analysis will confirm if this is CSF or sinus drainage. The next step is to get a CT scan of the brain done to identify the hole and the size.

Surgery follows all this.

Hope this helps.
Please do leave a positive rating for the service by clicking on the stars on top of the screen.

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Best wishes.

Customer: replied 6 months ago.
Thank you for the information. Now that I know what this is called, I can do further research on the internet. I also have more information to discuss with the surgical assistant at my appointment today. I am a little disappointed that this whole procedure has been fraught with so many unexpected side effects. Additional surgery would also be required to repair the septum which was affected the first time the radiation mask was strapped on my face for my first radiation treatment. I don't think my nose or my face will ever look the same but I've had enough of hospitals, doctor's appointments, etc. since September 2014 to last me a long time. If, indeed, I do have brain fluid leakage, I will do what is necessary to prevent future complications but at my age, I can stand a few minor imperfections. I was not a beauty at any point in my life and I'm certainly not so vain now that I am willing to undergo any further surgery. The scars will be my "badge of bravery".
Again, thank you for your help.
Sincerely,
Susan ********
PS: I prefer not to be inundated with medical information (unless I ask for it) and please do not pass my email address along to others who may not respect my wishes.
Expert:  Dr Uzair replied 6 months ago.

Do not worry, the site keeps its users anonymous.

Expert:  Dr Uzair replied 6 months ago.

.

Expert:  Dr Uzair replied 6 months ago.

Please do not forget to leave a positive rating by clicking on stars on top right corner.

Wish you good health.