Doctors fix infant's brain fluid leak via nose

In a rare case and after a much-delayed diagnosis, doctors have fixed a condition of an infant whose brain fluid was leaking out of her nose.

When 4-month-old Punyah Sharma was gripped with brain infection, her parents Gaurav (30) and Sandhya (27) were baffled. "On May 2, Punyah had fever. Paediatrician Dr Sanjeev Gupta from Saideep Hospital in Bhayander prescribed medicines for viral fever. There was no relief and she cried for seven hours at a stretch. She had closed her eyes. Earlier, she had vomited milk and was suffering from convulsions," said Gaurav.

What followed was a nightmare. Gaurav, an LIC insurance advisor, had to spend close to Rs5 lakh to get his baby cured.

After having spent two weeks in neo-natal intensive unit (NICU) at private-run Wockhardt Hospital in Mira Road, Punyah was shifted to the general ward after her fever reduced. In the night, as Punyah was sleeping, her mother noticed something strange. "The baby's pillow was wet with liquid. This occurred every night for some days. Earlier, doctors dismissed it as phlegm," said Gaurav.

As the doctors would later find out, it was cerebrospinal fluid (CSF) that was leaking from the brain through her nose. "It was a clear water-like substance. Sandhya collected the leaking samples from the baby's nose for three days and after testing it in the labs of PD Hinduja Hospital at Mahim, the mnature of it was established," explained Gaurav.

Punyah was subjected to a CT–Cisternography test, where a dye was injected in her spine. The doctors studied the route that CSF would adopt in the baby's brain, and through imaging techniques ascertained that there was a 1.4 – 1.8 mm hole in the bone between the skull base and the nose, through which CSF was leaking. "The baby was suffering from a rare condition called CSF Rhinorrhea," said Dr Neepa Vellimuttam, ENT surgeon at Wockhardt.

While earlier the parents were advised an open brain surgery by other doctors and had refused to amend the baby's condition, Dr Vellimuttam found a way to approach the hole through the nasal route. "We inserted an endoscope attached to a camera through the nose and then sealed the hole with fat harvested from the thigh," said Dr Vellimuttam. "We had to seal the hole, as an open leak could cause a re-infection in the brain for the baby."

Happy parents
Gaurav and Sandhya are elated that their baby Punyah is on the road to recovery. In 2014, they had lost their first baby, to a congenital heart defect, a hole in the heart, within nine days of birth and were devastated. "We were scared for our second baby, after a tragic incident with our first child last year. The doctors have salvaged Punyah's life and we are utterly grateful for that."