Senin, 07 Mei 2012

Brenda blamed her sniffles on hay fever

Brenda blamed her sniffles on hay fever

  • Her runny nose was in fact a symptom of a life-threatening condition

By Angela Brooks

PUBLISHED: 18:55 EST, 7 May 2012 | UPDATED: 18:55 EST, 7 May 2012

Brenda Foskett was bending down digging a flower bed when her nose suddenly started to drip. She put it down to hay fever, but over the next four months the problem continued â€" her nose just kept running.

Brenda, 45, a customer service assistant, went to her GP who diagnosed rhinitis, irritation of the nose lining, and prescribed a nasal spray. Over the next two years she tried to ignore the problem.

‘It was more of a nuisance than a worry,’ she says. ‘It would happen about once a day for a few seconds, usually when I was leaning forward.’

Life-saving surgery: Brenda Foskett, whose runny nose turned out to be something very serious

Life-saving surgery: Brenda Foskett, whose runny nose turned out to be something very serious

Then in summer 2008 Brenda, who lives with her husband, Steve, and two teenage sons in Amesbury, Wiltshire, developed a persistent headache. She also started to feel unsteady when she leaned forward.

After a CT scan and endoscopy to examine the inside of her nose came up with nothing, she was referred for an MRI scan.

‘By now it was August and I’d got to the point where I felt unsafe driving because I felt so dizzy when I twisted or tilted my head. I’d once narrowly missed hitting another car on a roundabout as a result. I had a bad feeling,’ she says.

‘Call it a woman’s instinct but I told my husband in the hospital car park before I went in that I was worried. He just laughed the way men do. But my instinct proved right.’

The MRI scan showed a mass in her sphenoid sinus. Sinuses â€" the air-filled cavities around the nose â€" filter and humidify the air we breathe and affect the resonance of the voice. There are four pairs of sinuses â€" maxillary, frontal, ethmoid and sphenoid â€" the sphenoid is the hardest to reach, deep set in the skull behind the eyes and tucked just under the brain.

‘I asked if he was talking about a tumour and he said, yes, possibly and they were going to have to biopsy it to find out. I prefer straight talking, but this was devastating.’

In September Brenda was admitted for the biopsy â€" in itself a major procedure. Two weeks later, the surgeon gave her the news she’d scarcely dared hope for â€" it wasn’t cancer. It was, however, a very peculiar type of benign tumour.

‘I felt really happy, although I could sense the mood was sombre. The surgeon then said: “The piece of tissue we biopsied in your sinus was part of your brain”.

‘I was stunned â€" I didn’t know what to say. He explained that the bony ceiling of the sphenoid is also the floor of the brain and some of this must have eroded â€" they didn’t know why â€" allowing a bit of my brain to drop down.

‘He said it is incredibly rare in adults, but that the tough membrane around that bit of the brain can occasionally rupture under pressure â€" as it had been when I was bending over gardening.

‘So what I thought was a drippy nose was in fact brain fluid. Part of me felt horrified and part of me was relieved it wasn’t cancer.’

The substance coming through Brenda’s nose was cerebospinal fluid â€" the brain is bathed continually in this fluid, which helps protect and nourish it.

While the loss of spinal fluid in itself was not a danger, Brenda’s condition meant that bacteria had an easy route into her brain, putting her at significant risk of the most serious form of meningitis, brain abscess, haemorrh age or stroke.

She was given an urgent referral to neurosurgeon Nijaguna Mathad  at Southampton General Hospital, whom she saw in October 2009.

‘Mr Mathad told me I was walking around with a time bomb in my head and I was going to need complex neuro-surgery to amputate the prolapsed piece of brain â€" about 2cm â€" and seal the hole. He said I’d be playing Russian roulette if I ignored it and he was astonished I wasn’t in a far worse state.

‘I couldn’t believe I had a life-threatening condition. I’d gone from having an occasional runny nose and dizziness to being a candidate for major surgery.

‘Part of me wanted to say: “I think you’ve got the wrong person”. My husband was shaking like a leaf.’

Mr Mathad felt that instead of traditional brain surgery â€" where surgeons drill a hole in the skull and lift the brain in a risky bid to access the sphenoid sinus, Brenda was a candidate for a groundbreaking operation that woul d be much less invasive.

Endoscopic endonasal skull base surgery â€" a technique developed by Mr Mathad and his colleagues â€" would allow him to tunnel through the nose to get to the sphenoid instead. He would remove the bit of the brain that had dropped down, and repair the roof of the sinus to prevent the problem recurring.

The bit being removed was from the medial temporal lobe â€" the lower part of the brain, which is responsible for memory and emotions. However, this wouldn’t affect Brenda because it was such a small area and was very scarred.

At the end of October, Brenda was admitted to Southampton General. Her husband, sons and best friend stayed by her side as she was wheeled into theatre.

‘I couldn’t allow myself to get weepy for the boys’ sake,’ she says, ‘and I told them I’d see them when I got out.’

Surprise: An MRI scan showed a mass in Brenda's sphenoid sinus (file picture)

Surprise: An MRI scan showed a mass in Brenda's sphenoid sinus (file picture)

Mr Mathad’s team then began five hours of painstaking surgery. First they put a slender instrument with a fibre-optic camera at the tip through one nostril and a tiny cutting instrument through the other.

Mr Mathad then created a corridor through the nose to the sphenoid sinus â€" this required enormous skill and the risks were high: the carotid artery â€" the major blood supply to the brain â€" was just 5mm away from where the surgeons were operating, and Brenda was warned that hitting it ‘would be the end’.

Meanwhile, the optic nerve was just 3mm away â€" a slip of the hand could have left her blind.

Once the scarred tissue was removed, surgeons used a segment of tissue from her thigh and tucked it under the exposed brain.

The thigh is tough and there is plenty of it, which means a small excision wouldn’t cause any side-effects. They then used another graft on top and held it in place with special glue.

Miraculously, the only sign that Brenda had been operated on immediately afterwards was two dressing packs in either nostril. And her surgeons were delighted with her progress.

‘I can’t believe how lucky I was,’ she says. ‘Sometimes Steve and I look at each other and I know we’re thinking the same thing â€" I had such a close escape.’

As she returned to normal, she took his teasing as a good measure of her recovery.

‘One day he said “I wonder which bit of the brain they removed. I hope it’s not the bit that does the housework”.’

It’s now been two-and-a-half years since she got the all clear.

‘I’ve got no more drippy nose, no headaches, no queasiness,’ she says. ‘The only reminder of what happened is that I’ve lost a bit of my sense of smell and sometimes cold air gives me a tingly feeling in my nose. But that’s it.

‘It’s so wonderful to not wake up every day feeling awful.’

 

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