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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 leak).


Looking for Cerebrospinal Fluid Leak Care?

  • Call us at 1-412-647-3685 or outside the U.S., call 1-877-320-8762.
  • Fill out our UPMC Neurosurgery contact form.

On this page:

  • What Is a Cerebrospinal Fluid Leak?
  • What Are the Symptoms of a Cerebrospinal Fluid Leak?
  • How Do You Diagnose a Cerebrospinal Fluid Leak?
  • How Do You Treat a Cerebrospinal Fluid Leak?

What Is a Cerebrospinal Fluid Leak?

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.

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.

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

What are the types of CSF leaks?

CSF fluid can leak from your:

  • Ears (CSF otorrhea).
  • Head.
  • Nose (CSF rhinorrhea). 

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

What is 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:

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

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

What causes cerebrospinal fluid leaks?

The causes of CSF leaks include: 

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

What are cerebrospinal fluid leak risk factors and complications? 

Cerebrospinal fluid leak risk factors

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.

Complications of a cerebrospinal fluid leak

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.

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

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

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.

Back to top.


What Are the Signs and Symptoms of a Cerebrospinal Fluid Leak?

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.
  • An orthostatic headache, which gets worse when you're upright and better when you lie down.
  • Changes in hearing or vision.

Other symptoms of a CSF leak include:

  • Balance problems.
  • Loss of smell. 
  • Loss of hearing in one ear.
  • Nausea and vomiting.
  • 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:

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

Symptoms of CSF otorrhea

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

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

Back to top.


How Do You Diagnose a Cerebrospinal Fluid Leak?

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

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.

Tests to diagnose a CSF leak

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

  • Cintilography
  • Cisternography
  • CT scan
  • MRI

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How Do You Treat a Cerebrospinal Fluid 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:

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

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.

Back to top.


By UPMC Editorial Staff. Last reviewed on 2024-10-18.

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