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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 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 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.
The characteristic symptom is orthostatic headache — a headache that worsens when you are upright and improves when you lie down.
Drainage from the nose (rhinorrhea), ear (otorrhea), or surgical wound may also be present.
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, 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 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.
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