CSF Rhinorrhoea (Endoscopic Nasal Repair) Nishit J Shah, Anamika Rathore
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1Step by Step® CSF Rhinorrhoea (Endoscopic Nasal Repair)
2Step by Step® CSF Rhinorrhoea (Endoscopic Nasal Repair)
Author Nishit J Shah MS DNB DORL Hon ENT Surgeon Bombay Hospital and Medical Research Centre Mumbai, India Co-author Anamika Rathore DNB DLO Hon ENT Surgeon Cumballa Hill Hospital Mumbai, India Foreword MV Kirtane
3Published by
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Step by Step® CSF Rhinorrhoea (Endoscopic Nasal Repair)
© 2009, Jaypee Brothers Medical Publishers
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the authors and the publisher.
First Edition: 2009
9788184485936
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4
To
My wife, Rachana
—Nishit J Shah
My late parents and my family
—Anamika Rathore
5Foreword
It is a pleasure to write a foreword for this Monogram on CSF Rhinorrhoea. Traditionally, repair of CSF leaks has been the domain of neurosurgeons, but, thanks to nasal endoscopes, it is now possible for ENT surgeons to access and repair the leak endoscopically.
The advantages of the nasal endoscopes are that it offers a better visualization of the leak site. It also enables precise localization of the leak and hence, is fast replacing the more invasive transcranial repairs except in certain situations.
Over the last decade, many ENT surgeons have started using the above technique for CSF repair and this book which, is a step by step guide to the same, can greatly help them to do it efficiently.
I am sure this Monogram will be helpful to all practising rhinologists and nasal endoscopists.
Dr. M V Kirtane
6Preface
Endoscopes have allowed us to enter a new world, a world with light, vision and brilliant anatomy. This is especially true for the nasal cavity, where the endoscope allows access, not just to the nose, but to the sinuses, the orbits and a large part of the skullbase. We now have major surgery with no external incisions, precise excision and reduced morbidity. We have travelled this long road from diagnostic nasal endoscopy to extensive skullbase surgery in a relatively short time. We have learned from allied specialities, looked at anatomy from a different perspective and modified instruments, all to the great advantage of the patient.
In this book, we have dealt with CSF Rhinorrhoea. We have tried to be comprehensive, yet keeping it simple and easy to read. All aspects, from history to diagnosis and surgery to postoperative care have been addressed, to have a complete overview.
In writing this book, I must acknowledge and thank my co-author, Dr Anamika Rathore, for her dedication and perseverance. She has spent many endless hours and days working tirelessly, and this endeavour would not have been possible without her efforts. I would also like to recognize the support I have received from Dr Milind Kirtane. He has been my teacher, guide and friend, and the inspiration in writing this book. I would also like to thank him for writing the foreword for this book. My neurosurgical colleagues at Bombay Hospital have been fantastic with their support and it is only through their much appreciated efforts that I have been educated and trained for skullbase surgery.
Finally, I would like to thank my family for always holding me up and pushing me forward, when the mind and body seemed weary and tired. My father, Dr J T Shah, from whom I learned the first steps of endoscopic sinus surgery and continue to learn the fine art of medical practice every single day. My mother, Smita, has been patient, gentle and understanding and nurtured in me, the values required to live in peace and happiness. And my wife, Rachana, from whom I have encouragement, fortitude and love.
Nishit J Shah
7Acknowledgements
I must thank the entire administrative staff at Bombay Hospital and Medical Research Centre for their help and support over the last 12 years that I have been associated with them. The Chairman, Mr Bharat Taparia, The Dean of the hospital, Dr B K Goyal and the medical director, Dr D P Vyas have all been outstanding in their help towards the ENT department, and I owe them a huge debt of gratitude.
The department of Neurosurgery has been the epicenter of all our skullbase work, and without their amazing support and co-operation, none of this would have been possible. Each one of our CSF repairs and over 550 other skullbase surgeries have been done in conjunction with our neurosurgical colleagues, and whilst all of them are co-authors, so as to speak, we would like to especially thank the following: Dr S N Bhagwati, Dr C E Deopujari, Dr K E Turel, Dr Rajan Shah, Dr Uday Andar, Dr Mahesh Chaudhary and Dr Suneel Shah.
Acknowledgement is also due to the staff of the Neurosurgery and the ENT operation theatres, as well as the ICU staff, our resident staff and the anaesthetists at Bombay Hospital.