YOUR HEALTH: Fixing a hole in your head

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PHILADELPHIA, Pennsylvania – Agnes McFadden, mother and grandmother, loves to travel and cook.   But three years ago, when her ear began leaking massive amounts of fluid, she had to put her life on hold.

"My pillows every night were completely covered by the morning."

Agnes was diagnosed with T.E.   There was a hole in her temporal bone which forms part of the skull.  It had to be surgically repaired.

The pulsating of her brain had created just enough pressure for cerebral fluid to go where it shouldn't: through a hole in her skull.

"It actually has a shelf and the brain sits on top of it and it's through that shelf bone that is oftentimes very thin, that the brain can have a defect and the bone can have a defect, and so the brain material and fluid from the brain can get into the ear space," explained Dr. Kadir Erkmen, the vice chairman of Neurosurgery at Temple University Hospital.

CAUSE: There are many different ways in which TE can develop.   It can be present at birth, developed after a traumatic head injury, and even after multiple ear infections.  In some cases, it can be developed from simply having a very thin temporal bone.  The brain naturally pulsates with every heartbeat 60 to 70 times per minute.   When the bone is very thin, the pulsations can break it down, an occurrence usually seen in people who are overweight.  TE is detected by the unresponsiveness of the ear infection to antibiotics allowing doctors to conclude that they're facing a bigger issue than an average ear infection and to proceed with the keyhole brain surgery.

As soon as her ear infections stopped, Agnes underwent groundbreaking endoscopic keyhole neurosurgery.  This unique operation uses tiny cameras inserted through an incision, less than two inches long, to repair the skull.

"Before, we had to make a very large incision, and shave half the head, and then put in retractors that really pushed the brain down, in order to repair these areas," Temple University Medical professor Dr. Pamela Roehm explained.

This approach, using the endoscope, was the brain child of doctors Erkmen and Roehm.  It offers better visualization and has very little impact on the healthy tissue.

The keyhole surgery uses bone, muscle, and a suture to seal up the hole.   Doctors say the defect can be present at birth, caused by a severe head injury, or even be the result of numerous ear infections.

But no matter how it happened, Agnes is back to business as usual.

"Wonderful.   Like nothing ever happened."

Doctors say that because a major risk of this condition is the possibility of spinal fluid entering the ear, meningitis can occur.

If this story has impacted your life or prompted you or someone you know to seek or change treatments, please let us know by contacting Jim Mertens at or Marjorie Bekaert Thomas at

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