Cerebrospinal Fluid Leak (CSF Leak)

Overview
Symptoms & Diagnosis
Treatment

What is Cerebrospinal Fluid Leak?

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.

What causes cerebrospinal fluid leaks?

Causes of Cerebrospinal Fluid (CSF) leaks include:

Trauma to the head or spine
Surgery
Tumors
Increased pressure in the brain from conditions such as hydrocephalus

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:

No incisions to heal
No disfigurement to the patient
Faster recovery time

Cerebrospinal Fluid (CSF) Leak Symptoms and Diagnosis

Symptoms of a CSF leak

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.

Tests for diagnosing a CSF leak

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:

CT scans
MRI scans
Cintilography
Cisternography

Cerebrospinal Fluid (CSF) Leak Treatments

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.

Surgery for CSF Leaks

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.

Endoscopic Endonasal Approach (EEA)
This animation shows the minimally invasive removal of a large tumor near the pituitary gland using the Endoscopic Endonasal Approach.

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