New Delhi, Mar 11th: Doctors at Manipal Hospital Dhakuria, a unit of one of the largest healthcare providers of India – Manipal Hospitals Group, successfully treated a rare congenital brain condition known as meningoencephalocele with CSF rhinorrhoea in a 29–year–old patient, Atanu Pandit, from Narayanpur village in the Arambag region of West Bengal. The condition occurs when a portion of the brain and its protective covering extends through a defect in the skull into the nasal cavity, leading to leakage of cerebrospinal fluid (CSF) from the nose.
The patient was treated under the care of Dr. Kaushik Sil, Consultant – Neurosurgery at Manipal Hospital Dhakuria, with support from the ENT team led by Prof. Dr. Amitabha Roychoudhury, Consultant – ENT at Manipal Hospital Dhakuria.
Atanu Pandit had been experiencing a constant discharge of clear watery fluid from his nose for several years, which was ignored at the beginning and thought to be a minor nasal issue. However, medical examination later confirmed that the fluid was cerebrospinal fluid (CSF), a clear, protective fluid that surrounds and cushions the brain and spinal cord, protecting them from injury and maintaining proper pressure inside the skull, is leaking from the brain. This condition is medically termed as CSF rhinorrhoea. When Atanu was around four years old, a similar growth had appeared inside his nose. At the time, local doctors examined it and believed it to be a nasal polyp, a condition commonly seen in such cases in rural settings. They attempted to examine and treat the growth locally. During this process, a fluid discharge was noticed once, but the swelling eventually subsided on its own. As no further symptoms were observed, the condition was not pursued medically, and he did not seek treatment again for many years.
However, due to the underlying congenital defect, a portion of the brain tissue had gradually extended into the nasal cavity over time, eventually forming a soft, polyp-like mass along the inner surface of the nose.
Further diagnosis revealed that the patient had a large defect in the anterior skull base, the partition that separates the brain from the facial cavity.
MRI scans confirmed the diagnosis of meningoencephalocele which is a rare birth defect where brain tissue and its coverings herniate through a gap in the skull base. Such cases are extremely rare and occur in roughly 1 in 35,000 to 40,000 individuals. If the situation is left untreated, the condition can lead to recurrent infections, multiple neurological complications, or life-threatening meningitis.
Atanu Pandit was admitted to Manipal Hospital, Dhakuria on 29th December. After a detailed clinical evaluation and imaging tests including both MRI and CT scans, it confirmed the presence of a large skull base defect and herniation of brain tissue into the nasal cavity. Considering the complexity and seriousness of the condition, doctors planned a combined neurosurgical and ENT procedure to repair the defect from both the brain and nasal sides.
During the surgery, the neurosurgical team led by Dr. Kaushik Sil carefully opened the skull and approached the defect from beneath the brain. Using advanced microsurgical procedures, they removed the herniated brain tissue and repaired the skull base using a muscle graft taken from the patient’s own thigh.
Simultaneously, the ENT team led by Prof. Dr. Amitabha Roychoudhury approached the condition through the nasal cavity, removing the detached brain tissue and reconstructing the upper part of the nasal cavity and sealing the defect completely. The surgery was conducted successfully with the support of anaesthesiologist Dr. Prakhar Gyanesh, and the patient had an uneventful recovery. He was discharged on the fifth day after surgery and has since shown excellent recovery with complete blockage of the fluid leak and no residual symptoms.
Speaking about the case, Dr. Kaushik Sil said, “Meningoencephalocele with CSF rhinorrhoea is a rare and highly challenging situation that needs careful planning and multi-disciplined coordination. In this case, the patient had a large congenital issue in the skull base through which brain tissue had descended into the nasal cavity for over many years. Such conditions carry a risk of serious infection if goes untreated. Through a combined neurosurgical and ENT approach, we were able to remove the herniated brain tissue and reconstruct the skull base effectively. The patient’s smooth and quick recovery highlights the importance of early intervention and diagnosis, advanced surgical techniques, and coordinated specialist care.”
Prof. Dr. Amitabha Roychoudhury, Consultant – ENT, Manipal Hospital Dhakuria, said, “In this case, a portion of the brain had descended into the nasal cavity through a congenital skull base defect, which is an extremely rare situation. From the ENT perspective, our role was to carefully remove the herniated tissue from the nasal cavity and repair the upper nasal passage to ensure that the leak was completely sealed. Such complex cases require accurate coordination between neurosurgery and ENT teams. With a combined approach and advanced infrastructure, we were able to safely treat the condition and restore normal function for the patient”.
Expressing his gratitude, Mr. Atanu Pandit said, “For many years I was worried about the continuous fluid leaking from my nose but did not know the actual reason behind it. When I came to Manipal Hospital Dhakuria, the doctors explained my condition in detail and assured me that it is treatable. From admission to surgery and recovery, the entire team took very good care of me. I am now completely recovered and highly grateful to the doctors and staff for giving me a new life and confidence.”
This case highlights the advanced neurosurgical expertise, multidisciplinary collaboration, and modern infrastructure available at Manipal Hospital Dhakuria, and the importance of early diagnosis.
