Student, Resident, and Faculty Perceptions on Providing Excellent Surgical Education: A Qualitative Analysis

Case: A 46-year-old female with history of migraines, obesity and hypertension presented to PCP for left-sided rhinorrhea, headaches and nausea for several months.Patient was seen by multiple providers and conservatively managed with Zofran, nasal decongestants and cold remedies without relief.She denied any recent infections or trauma.Further questioning revealed that headache and rhinorrhea were positional and accompanied by metallic tasting PND, raising suspicion for cerebrospinal fluid rhinorrhea.CT head (Figure 1) was ordered showing partial empty sella and thinning/defect of the left sphenoid sinus roof.Nasal discharge tested positive for Beta-2 transferrin confirming cerebrospinal fluid leak.Patient subsequently underwent nasoseptal flap repair via a transsphenoidal approach.Rhinorrhea resolved after surgery and symptoms improved. Conclusion:This case highlights the importance of identifying clues in patient history leading to appropriate diagnosis.Beta2transferrin assay is currently the single best laboratory test for identifying the presence of CSF in sinonasal fluid.Other tests may include MRI, CT, or cisternography.These tests can help to locate the source of the leak and determine the best treatment option.Conservative treatment aims to reduce intracranial pressure, while surgical treatment involves repairing the leak by using a patch, glue, graft, or flap repair.