Cerebrospinal fluid (CSF) surrounds the spine and brain, acting mainly as a protective cushion. A tear in one of the membranes containing the CSF allows the fluid to leak out.
CSF can leak from the nose, ears, or from a head or spinal wound. As the fluid drains, its cushioning power decreases, and the brain begins to rest directly on the skull. The result is headaches that worsen upon sitting or standing.
Causes of Cerebrospinal Fluid (CSF) leaks include:
Spontaneous CSF leaks are associated with developmental defects of the skull bones that cause the membranes (meninges) to protrude. An opening in the membranes makes the nervous system more susceptible to infection.
When left untreated, 25 to 50 percent of CSF leaks lead to meningitis.
The preferred surgical treatment at UPMC for Cerebrospinal Fluid (CSF) leaks of the skull base is the Endoscopic Endonasal Approach (EEA). This innovative, minimally invasive technique uses the nose and nasal cavities as natural corridors to access hard-to-reach areas or previously inoperable tumors.
The benefits of EEA include:
Your doctor may ask you about any symptoms that you are experiencing.
Those experiencing cerebrospinal fluid leaks may have a clear, watery substance drain from one ear or side of the nose, particularly when they move or tilt their head. This may be accompanied by changes in hearing or vision.
A characteristic symptom is also orthostatic headache, which is a headache that worsens when you are upright and improves when you lie down.
If you have drainage, your doctor may collect a sample for testing. If it contains beta-2-transferrin — a protein specific to CSF — he or she can make a positive diagnosis.
To confirm the diagnosis and locate the CSF leak, your doctor may also order imaging studies such as:
Many CSF leaks repair themselves within a week to six months, especially those that have a traumatic origin. Your doctor may instruct you to rest and give you pain relievers for the headache.
If leakage persists, other treatment options may need to be considered. You may need an epidural blood patch injection at the site of the leak to block it.
Some cases require surgery, including repair to spontaneous leaks and most traumatic leaks involving skull base defects, which require repair of the bone and the meningeal tear.
If surgery is necessary, UPMC surgeons will use the Endoscopic Endonasal Approach (EEA) to repair CSF leaks of the skull base.
This approach allows surgeons to see and repair the CSF leak without making an open incision. They perform EEA through the nose and nasal cavities, and recovery time is faster than with traditional open surgery.
A lumbar drain may also be necessary in certain cases.
How can we help you?
Schedule anappointment »
Ask a question »
Request our expertopinion »
1-877-986-9862(within the U.S.)
Affiliated with the University of Pittsburgh Schools of the Health Sciences
| Supplemental content provided by Healthwise, Incorporated. To learn more, visit www.healthwise.org
For help in finding a doctor or health service that suits your needs, call the UPMC Referral Service at 412-647-UPMC (8762) or 1-800-533-UPMC (8762). Select option 1.
UPMC is an equal opportunity employer. UPMC policy prohibits discrimination or harassment on the basis of race, color, religion, ancestry, national origin, age, sex, genetics, sexual orientation, gender identity, marital status, familial status, disability, veteran status, or any other legally protected group status. Further, UPMC will continue to support and promote equal employment opportunity, human dignity, and racial, ethnic, and cultural diversity. This policy applies to admissions, employment, and access to and treatment in UPMC programs and activities. This commitment is made by UPMC in accordance with federal, state, and/or local laws and regulations.
Medical information made available on UPMC.com is not intended to be used as a substitute for professional medical advice, diagnosis, or treatment. You should not rely entirely on this information for your health care needs. Ask your own doctor or health care provider any specific medical questions that you have. Further, UPMC.com is not a tool to be used in the case of an emergency. If an emergency arises, you should seek appropriate emergency medical services.
Pittsburgh, PA, USA | UPMC.com