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​Cerebrospinal Fluid Leak (CSF Leak)

When the cerebrospinal fluid (CSF) surrounding the brain and spinal cord leaks, this is called a cerebrospinal fluid leak (CSF).

Discover the treatment options for Cerebrospinal Fluid Leak at the UPMC Pituitary Center of Excellence.

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What Is Cerebrospinal fluid (CSF)?

Cerebrospinal fluid (CSF) surrounds and protects the spine and brain. A tear in one of the membranes that contains the CSF allows the fluid to leak out.

What Is a Cerebrospinal Fluid Leak?

A CSF leak is a serious medical problem that requires medical treatment.

CSF fluid can leak from your:

  • Nose.
  • Ears.
  • Head.

CSF can also leak from a spinal wound or a blister in the lining of a spinal nerve.

As the fluid drains, its power to cushion lessens, and the brain begins to rest directly on the skull. The result is headaches that worsen when you sit or stand.

Plus, if CSF drains into the ear or nose, you have an increased risk of meningitis and/or hearing loss.

What causes cerebrospinal fluid leaks?

Th causes of CSF leaks include:

  • Trauma to the head or spine.
  • Surgery.
  • Tumors.
  • Increased pressure in the brain from issues such as hydrocephalus or pseudotumor.

Spontaneous CSF leaks can happen for no known reason but have links to:

  • Developmental defects of the skull bones that cause the membranes (meninges) to stick out.
  • Increased pressure from obesity.
An opening in the membranes makes the nervous system more prone to infection.

When not treated, 25 to 50% of CSF leaks can lead to meningitis.

What Are the Long-Term Side Effects of a CSF Leak?

If left untreated, a CSF leak can cause a few long-term side effects. These may include:

  • Headaches.
  • Seizures.
  • Meningitis.
  • Pneumocephalus.
  • Hearing loss.

Treatment significantly lessens the odds of having one of these side effects.

But even though surgical treatments have high success rates, some people may still have symptoms after surgery. This can be from continuous CSF leakage or increased pressure in the head after surgeons plug the leak.

CSF Rhinorrhea

CSF rhinorrhea is when a rupture to the CSF that cushions the brain and spinal cord causes fluid to run from the nose. This can happen because of:

  • Issues present at birth.
  • Head trauma.
  • Intracranial surgery.
  • Increased pressure in the brain.

If not treated, CSF rhinorrhea can lead to serious health problems, such as meningitis or other dangerous infections.

Cerebrospinal Fluid (CSF) Leak Symptoms and Diagnosis

Symptoms of a cerebrospinal fluid (CSF) leak

To diagnose a CSF leak, your doctor may ask you about symptoms you're having.

People with CSF leaks may have:

  • A clear, watery substance drain from one ear or side of the nose when they move or tilt their head.
  • Changes in hearing or vision.
  • An orthostatic headache, which gets worse when you're upright and better when you lie down.

Other symptoms of a CSF leak include:

  • Nausea and vomiting.
  • Loss of smell.
  • Balance problems.
  • Loss of hearing in one ear.
  • Neck stiffness and pain.
  • Pain between the shoulder blades.

Symptoms of CSF Rhinorrhea

Some symptoms relate only to CSF rhinorrhea and a leak from the nose. These include:

  • Headache that gets worse when you sit up and improves when you lie down.
  • Salty or metallic taste in the back of your throat.
  • Clear, watery drainage, often from only one side of the nose or one ear.
  • Vision changes.
  • Changes to your hearing, such as ringing in your ears.
  • Sensitivity to light and sound.

Symptoms of CSF Otorrhea

CSF otorrhea, or a CSF leak into the ear, can lead to:

  • A decrease in hearing.
  • Full sensation in the ear.
  • Fluid buildup behind the eardrum.
  • Clear, watery drainage from the ear after placement of a tympanostomy (T) tube.

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 found only in CSF — they can diagnose a CSF leak.

To confirm the diagnosis and find where the CSF leak is, your doctor may also order imaging studies, such as:

  • CT scan.
  • MRI.
  • Cintilography.
  • Cisternography.

Treatment for CSF Rhinorrhea (Nasal Leak)

CSF leaks may go away on their own, especially if they occur after trauma. Your doctor may tell you to rest and give you pain relievers for the headache.

But if the leak persists, your doctor may look at other treatment options, such as surgery.

For spinal leaks, you may need an epidural blood patch injection to seal it.

Surgery for CSF Leaks

Some CSF leaks need surgery, including repair of spontaneous leaks and most traumatic leaks involving skull base defects. Surgeons must repair the bone and the meningeal (brain lining) tear.

To repair CSF leaks of the skull base with surgery, UPMC surgeons use the Endoscopic Endonasal Approach (EEA), or team surgery via a “middle fossa approach." This innovative, minimally invasive technique uses the nose and nasal cavities as natural corridors for hard-to-reach areas or previously inoperable tumors.

The benefits of EEA include:

  • No incisions to heal.
  • No scarring.
  • Faster return to health.

Our expert team of ear (neuro-otology) surgeons and neurosurgeons manage spontaneous CSF leaks into the ear. They repair the hole between the brain and ear, and separate and preserve both using your own tissues.

The EEA allows our surgeons to see and repair the CSF leak without making an open incision. We perform EEA through the nose and nasal cavities, and recovery time is faster than with traditional open surgery.

Certain cases may also require a lumbar drain. For spontaneous leaks, surgeons may need to look for intracranial pressure/pseudotumor.