Girl's leaking brain fluid mistaken for cold; finally operated upon

Akanksha suffered from a congenital brain disease

Akanksha, a seven-year-old from Nashik, left doctors in Mumbai stunned when they discovered that she has been passing brain fluid from her nose her entire life, which was misunderstood as a cold. Due to a rare congenital defect, the brain fluid was running straight through the nose, which would have proved deadly if she had developed a brain infection. The doctors took skin from her leg to develop a vital portion, which was missing in her brain, to block the fluid.

In 2012, the family welcomed their firstborn, Akanksha, who was declared a healthy child by the doctors. But soon, she developed a runny nose. Her parents considered cold and fever as the underlying cause for it. Even after seeing several doctors, no one could actually stop it. When she turned seven, her parents brought her to Mumbai, where she was diagnosed with congenital nasal meningoencephalocele.

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Congenital nasal meningoencephalocele is caused by a congenital defect in the skull base in the roof of the nose, which allows brain fluid to accumulate in a nasal bag called meningoencephalocele. The bag can rupture and make brain fluid flow through the nose. The revelation not only shocked her parents, but also the doctors.

Her treating doctor, Dr Sanjay Helale, ENT surgeon from Kohinoor Hospital, said, "Brain fluid coming out of the nose is common during accidents, but not because of a congenital defect. After taking the consent of her parents, we decided to operate her through the nose with the help of an endoscope using the four-hands technique, in which two surgeons operate on the patient at the same time. We used her leg skin to replace this portion and planted it successfully. Apart from being a complicated surgery, the real challenge was to operate through a seven-year-old's tiny nasal area, and also putting her on anaesthesia for four hours."

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Speaking to mid-day, her mother Rajani Joshi said that they never understood that fluid from her brain was pouring out of her nose, until doctors accurately diagnosed her. "We thought it is because of cold. Whenever she used to jump around or play for a longer time, the fluid would come out. That's why she always used to carry a cotton handkerchief with her." The health condition could have proved deadly, causing a brain infection. "The nostril is directly connected to the brain," said Dr Paras Kothari, a paediatric surgeon from Sion Hospital. "And the membrane is attached inside the nose. In this case, as there was an opening through which the brain fluid was coming out, her brain could have been infected, which would have been fatal. This is what makes this case among the rarest of rare."

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