Duke Skull Base Surgeons Diagnose and Treat Rare Cause of Debilitating Headaches in Young Boy | Duke Health
Archived: 2026-04-23 17:12
Duke Skull Base Surgeons Diagnose and Treat Rare Cause of Debilitating Headaches in Young Boy | Duke Health
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Pediatric neurosurgeon Amanda Jenson, MD, shows Brayden and his family a 3D model of his skull, which was used to plan Brayden's first surgery.
At just nine years old, severe
headaches
and eye pain caused young Brayden Bardonado to spend most days in bed. That changed when Duke Health surgeons identified and corrected the rare cause of his symptoms. Today, Brayden’s pain is gone, and his mother, Deanna Semanoff, sings Duke’s praises. “I have my son back. It's such an incredible feeling,” Brayden’s mom said. “Duke saved my son’s life.”
A Condition So Uncommon, Only Two Other Cases Reported
Brayden was ultimately diagnosed with a cerebrospinal fluid lymphovascular fistula, a condition that has only been reported in two other children worldwide. An abnormal connection between the subarachnoid space, which is an area between two layers of the brain, and veins or lymphatic structures was allowing
cerebrospinal fluid (CSF) to leak
away from Brayden’s brain, eroding his skull base, and causing his brain to sag. The result was excruciating eye pain and headaches. “He was suffering so severely,” Semanoff said. “He would cry for hours every day.”
Searching for Answers
But Brayden didn’t receive his diagnosis right away. In June 2024, Brayden was admitted to a hospital near his home in Lehighton, PA because his pain had become unbearable. Doctors didn’t like what they saw. The dura, the brain’s protective lining, was sagging, and cerebrospinal fluid was leaking through small holes in Brayden’s skull base, but no one knew why. Brayden needed surgery, but doctors cautioned that it was too risky. They suggested trying Duke Health.
Duke Says Yes
Three days later, Brayden and Semanoff met with Duke’s
Amanda Jenson, MD
, a pediatric neurosurgeon who specializes in treating complex conditions of the skull base in children. She believed she could help. “To me, it was too risky to not try something, because Brayden’s symptoms were completely debilitating.”
The 3D model of Brayden's skull shows enlarged openings and erosion on one side of his skull base..
The Journey Begins
In December 2024, Dr. Jenson joined forces with Duke head and neck surgeon
Ralph Abi Hachem, MD
, to access Brayden’s skull base through his nostrils. Together, the surgeons used a synthetic material to seal the holes in Brayden’s skull and patched the area with a flap made from Brayden’s nasal tissue.
A Significant Improvement
Brayden returned home, and over the next few months, his symptoms almost completely resolved. “He went from lying in bed for hours suffering to having a tiny headache for maybe 20 minutes a day,” Semanoff said. As time passed, however, the headaches returned.
Surgeries Reveal Surprises
In June 2025, Brayden returned to Duke where advanced imaging showed the patch had held successfully, but CSF was now leaking in a new place near the cavernous sinus, which contains a bundle of facial nerves. Operating in this area risked nerve damage, so Dr. Jenson opened the skull to access the brain and repaired the new leak without accessing the cavernous sinus.
A week later, imaging showed the leak persisted. This time, Dr. Jenson partnered with Duke neurosurgeon
Ali Zomorodi, MD
, to access the cavernous sinus. Normally, the area is filled with blood, but the surgeons were shocked to find it filled with CSF instead. “Neither of us had ever seen or even heard of that before,” Dr. Jenson said. “It was incredibly unusual.”
This discovery revealed that a fistula was causing the CSF leaks. “It could have been there from birth -- we don’t know -- but this was definitely the source of his problems,” Dr. Jenson said. The surgeons repaired the fistula by packing fat, taken from Brayden’s abdomen, in the area and applying a synthetic sealant that can be safely used in the brain. Dr. Jenson also inserted a drain to direct any excess CSF away from the brain.
Feeling Better than Ever
Following his last procedure in August 2025, Brayden has been headache-free. He celebrated his twelfth birthday in March 2026 by attending a follow-up appointment at Duke and got a great report. He’s looking forward to returning to school in the fall.
“I'm so grateful for where he is today, and I feel like he has a shot at a normal life now,” Semanoff said. “Duke truly saved his life.”
Brayden smiles with his family and part of his Duke Health care team.
Sharing Brayden’s Story to Help Others
Because only two other cases of cerebrospinal fluid lymphovascular fistula have been reported, Dr. Jenson and her colleagues recently shared their experience at a recent national meeting of skull base surgeons. Doing so offers guidance for other skull base surgeons if additional cases arise in the future.
“That's why I am in this specialty,” Jenson said. “I love seeing incredibly rare pathologies like this, and I want to help as many people as I can.”
Learn More About
Skull Base Defects in Children
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Featured Doctors
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Amanda V. Jenson, MD
Pediatric Neurosurgeon
Featured Doctors Images
Ralph Abi Hachem, MD, MSc
Ear, Nose and Throat Doctor, Head and Neck Surgeon, Sinus Specialist
Featured Doctors Images
Ali R. Zomorodi, MD
Neurosurgeon
Related Doctors
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A Second Opinion at Duke Leads to Successful Removal of...
Camden Fisher was three years old when she was diagnosed with cavernous malformations, also known as cavernomas. The tangled bundles of small, thin-walled blood vessels can leak or hemorrhage, causing headaches, seizures, weakness, and stroke-like symptoms. Despite multiple surgeries, her symptoms persisted. After a second opinion at Duke Health, Duke neurosurgeons completely removed the cavernoma that caused her problems. “We’re just so grateful that she’s thriving,” said Camden’s mom, Sara Fisher.
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Amanda V. Jenson, MD
Pediatric Neurosurgeon
Featured Doctors Images
Ralph Abi Hachem, MD, MSc
Ear, Nose and Throat Doctor, Head and Neck Surgeon, Sinus Specialist
Featured Doctors Images
Ali R. Zomorodi, MD
Neurosurgeon
Related Doctors
Back to Top
Support Duke Health research or honor a loved one with a tribute gift.
Giving to Duke Health
Skip Navigation
Duke Header Image Link
Schedule with My Duke Health (MyChart)
As a returning patient for this doctor, please schedule an appointment using your My Duke Health (MyChart) account.
Sign In to My Duke Health (MyChart)
Don't have a My Duke Health (MyChart) account?
Sign up now
Account Help
If you have trouble logging in, have questions about how to use My Duke Health (MyChart), need more information about
your account, or need to contact customer service, please
view our FAQs
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Home
Blog
Children's Health Articles
Ready for an appointment?
Call us at
855-855-6484
Pediatric neurosurgeon Amanda Jenson, MD, shows Brayden and his family a 3D model of his skull, which was used to plan Brayden's first surgery.
At just nine years old, severe
headaches
and eye pain caused young Brayden Bardonado to spend most days in bed. That changed when Duke Health surgeons identified and corrected the rare cause of his symptoms. Today, Brayden’s pain is gone, and his mother, Deanna Semanoff, sings Duke’s praises. “I have my son back. It's such an incredible feeling,” Brayden’s mom said. “Duke saved my son’s life.”
A Condition So Uncommon, Only Two Other Cases Reported
Brayden was ultimately diagnosed with a cerebrospinal fluid lymphovascular fistula, a condition that has only been reported in two other children worldwide. An abnormal connection between the subarachnoid space, which is an area between two layers of the brain, and veins or lymphatic structures was allowing
cerebrospinal fluid (CSF) to leak
away from Brayden’s brain, eroding his skull base, and causing his brain to sag. The result was excruciating eye pain and headaches. “He was suffering so severely,” Semanoff said. “He would cry for hours every day.”
Searching for Answers
But Brayden didn’t receive his diagnosis right away. In June 2024, Brayden was admitted to a hospital near his home in Lehighton, PA because his pain had become unbearable. Doctors didn’t like what they saw. The dura, the brain’s protective lining, was sagging, and cerebrospinal fluid was leaking through small holes in Brayden’s skull base, but no one knew why. Brayden needed surgery, but doctors cautioned that it was too risky. They suggested trying Duke Health.
Duke Says Yes
Three days later, Brayden and Semanoff met with Duke’s
Amanda Jenson, MD
, a pediatric neurosurgeon who specializes in treating complex conditions of the skull base in children. She believed she could help. “To me, it was too risky to not try something, because Brayden’s symptoms were completely debilitating.”
The 3D model of Brayden's skull shows enlarged openings and erosion on one side of his skull base..
The Journey Begins
In December 2024, Dr. Jenson joined forces with Duke head and neck surgeon
Ralph Abi Hachem, MD
, to access Brayden’s skull base through his nostrils. Together, the surgeons used a synthetic material to seal the holes in Brayden’s skull and patched the area with a flap made from Brayden’s nasal tissue.
A Significant Improvement
Brayden returned home, and over the next few months, his symptoms almost completely resolved. “He went from lying in bed for hours suffering to having a tiny headache for maybe 20 minutes a day,” Semanoff said. As time passed, however, the headaches returned.
Surgeries Reveal Surprises
In June 2025, Brayden returned to Duke where advanced imaging showed the patch had held successfully, but CSF was now leaking in a new place near the cavernous sinus, which contains a bundle of facial nerves. Operating in this area risked nerve damage, so Dr. Jenson opened the skull to access the brain and repaired the new leak without accessing the cavernous sinus.
A week later, imaging showed the leak persisted. This time, Dr. Jenson partnered with Duke neurosurgeon
Ali Zomorodi, MD
, to access the cavernous sinus. Normally, the area is filled with blood, but the surgeons were shocked to find it filled with CSF instead. “Neither of us had ever seen or even heard of that before,” Dr. Jenson said. “It was incredibly unusual.”
This discovery revealed that a fistula was causing the CSF leaks. “It could have been there from birth -- we don’t know -- but this was definitely the source of his problems,” Dr. Jenson said. The surgeons repaired the fistula by packing fat, taken from Brayden’s abdomen, in the area and applying a synthetic sealant that can be safely used in the brain. Dr. Jenson also inserted a drain to direct any excess CSF away from the brain.
Feeling Better than Ever
Following his last procedure in August 2025, Brayden has been headache-free. He celebrated his twelfth birthday in March 2026 by attending a follow-up appointment at Duke and got a great report. He’s looking forward to returning to school in the fall.
“I'm so grateful for where he is today, and I feel like he has a shot at a normal life now,” Semanoff said. “Duke truly saved his life.”
Brayden smiles with his family and part of his Duke Health care team.
Sharing Brayden’s Story to Help Others
Because only two other cases of cerebrospinal fluid lymphovascular fistula have been reported, Dr. Jenson and her colleagues recently shared their experience at a recent national meeting of skull base surgeons. Doing so offers guidance for other skull base surgeons if additional cases arise in the future.
“That's why I am in this specialty,” Jenson said. “I love seeing incredibly rare pathologies like this, and I want to help as many people as I can.”
Learn More About
Skull Base Defects in Children
SHARE:
Featured Doctors
Featured Doctors Images
Amanda V. Jenson, MD
Pediatric Neurosurgeon
Featured Doctors Images
Ralph Abi Hachem, MD, MSc
Ear, Nose and Throat Doctor, Head and Neck Surgeon, Sinus Specialist
Featured Doctors Images
Ali R. Zomorodi, MD
Neurosurgeon
Related Doctors
You May Also Be Interested In...
A Second Opinion at Duke Leads to Successful Removal of...
Camden Fisher was three years old when she was diagnosed with cavernous malformations, also known as cavernomas. The tangled bundles of small, thin-walled blood vessels can leak or hemorrhage, causing headaches, seizures, weakness, and stroke-like symptoms. Despite multiple surgeries, her symptoms persisted. After a second opinion at Duke Health, Duke neurosurgeons completely removed the cavernoma that caused her problems. “We’re just so grateful that she’s thriving,” said Camden’s mom, Sara Fisher.
Read Article
Hemispherectomy Cures Epilepsy in Young Girl, Now Thriving
Read Article
Epilepsy Surgery in Infancy Allows Toddler to Walk, Talk, and...
Read Article
Minimally Invasive Procedure Corrects Vein of Galen...
Read Article
Featured Doctors
Featured Doctors Images
Amanda V. Jenson, MD
Pediatric Neurosurgeon
Featured Doctors Images
Ralph Abi Hachem, MD, MSc
Ear, Nose and Throat Doctor, Head and Neck Surgeon, Sinus Specialist
Featured Doctors Images
Ali R. Zomorodi, MD
Neurosurgeon
Related Doctors
Back to Top
Support Duke Health research or honor a loved one with a tribute gift.
Giving to Duke Health