34-year-old Çise Atlas applied to many physicians with the complaint of runny nose occurring as a transparent clear fluid drainage during postpartum a year ago. Each time, she was diagnosed with allergic nasal discharge and received allergic treatment. Despite the allergic medication for a year, the patient began to struggle with health problems such as fatigue, weakness and headache due to increase in nasal fluid discharge. As the symptoms did not improve significantly upon symptomatic allergic treatment, the patient applied to Near East University Hospital to receive a more extensive assessment. Following the tests, the nasal fluid was detected as cerebrospinal fluid. Since Cerebrospinal fluid (CSF) leak occurs when there is a tear or a hole in the membranes surrounding the brain or spinal cord, further imaging tests were carried out to determine the exact location of the leak. A tear on the brain membrane at the skull base was detected. For cerebrospinal fluid leaks due to tear or hole on the brain membrane, surgery is necessary to repair the leak. The patient has undergone a successful operation and the tear on the brain membrane has been repaired by the team under the helm of Professor Ferhat Erişir, the Head of Otorhinolaryngology and the Head and Neck Surgery Department.

Professor Dr. Ferhat Erişir: “Accidents, Traumas, Knocks received on Nose, and Complications Experienced during Previous Surgeries Can Cause a Tear or a hole in the Membrane of the Brain and Spinal Cord"
Based on the patient's history, the results of examinations, tests and further imagining tests, a surgery was decided to be performed to repair cerebrospinal fluid leak. Since Near East University Hospital Department of Otorhinolaryngology and the Head and Neck Surgery has extensive experience in the use of nasal endoscopy, which is much less invasive than traditional surgical methods, it was decided that the operation would be performed by the team under the helm of the Department Head Professor Ferhat Erişir.

Underlining that Cerebrospinal fluid (CSF) leak occurs when there is a tear or a hole in the membranes surrounding the brain or spinal cord, allowing the clear fluid that surrounds and cushions those organs to escape, Professor Ferhat Erişir delivered information regarding the patient: "Our patient Çise Atlas had undergone a nasal surgery many years ago. Years after the nasal surgery, she gave a birth. It is possible that a thinning in the membrane, which might occur as a potential complication of nasal surgery, had combined with the pressure during delivery and resulted as a tear in the brain membrane. After delivery, cerebrospinal fluid began to flow from the patient's nose slowly and drop by drop.”

Highlighting that injuries, accidents, traumas, nasal blows may be among the primary causes of nasal cerebrospinal fluid leak, Professor Erişir noted that previous operations that the patients undergone and postoperative complications that experienced may cause CSF leak.

Professor Ferhat Erişir: "It would have been inevitable that the Patient would have to fight against meningitis if She hadn't been diagnosed and treated properly..."
Referring to cerebrospinal fluid CSF) and its functions, Prof. Dr. Ferhat Erişir stated that the brain produces roughly up to a glass of cerebrospinal fluid per day and drew attention that CSF protects the brain tissue from traumas by acting as a mechanical barrier.

Underlining that meningitis is a risk factor associated with cranial CSF leaks, Professor Erişir stated that Çise Atlas, who was misdiagnosed with allergic runny nose and received allergic medication for a year, was under the risk of developing meningitis due to excessive cerebrospinal fluid leak that resulted from a tear in the membrane surrounding the brain. The patient was diagnosed accurately and treated timely thanks to the high-tech equipped Near East University Hospital and her specialized and experienced physicians. It would have been inevitable that the patient would have developed meningitis if she hadn't been diagnosed accurately and treated timely. Those with continuous nasal discharge in the form of clear fluid should consult to a specialist”.

Prof. Dr. Ferhat Erişir: "The Patient was treated by applying a patch on the brain base through Nasal Route"
Underlining the importance of the accurate localization of the site of lesion for a successful endoscopic repair of CSF leak, Professor Erişir delivered information regarding the surgical procedure: "Since the hole in the brain membrane was located at the brain base, we decided to repair the CSF leak via an transnasal endoscopic surgery which is much less invasive than traditional surgical methods. The surgery was performed by the nasal route using endoscopic cameras to proceed towards the brain base and patch the hole on the membrane. The hole was closed with a patch and the patient's health restored successfully” noted he.

Highlighting the fact that CSF leak due to a tear or a hole in the membranes surrounding the brain or the spinal cord may cause some serious symptoms, Professor Erişir stated that positional headache, which worsens while sitting upright and relieves while lying down, is one of the significant symptoms of CSF leak.

“Patients with CSF leak suffer from severe headache which may even persist for a short time after surgery. In case of delay in diagnosis and treatment, microbes via nasal route can infect the membranes (meninges) surrounding the brain and spinal cord and the patient may develop meningitis which can be life-threatening. Following the operation performed in our hospital, the patient's nasal discharge and headaches resolved spontaneously and all problems that could pose a life-risk have been eliminated” said he.