When the cerebrospinal fluid (CSF) surrounding the brain and spinal cord leaks, this is called a cerebrospinal fluid leak (CSF).
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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.
A CSF leak is a serious medical problem that requires medical treatment.
CSF fluid can leak from your:
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.
Th causes of CSF leaks include:
Spontaneous CSF leaks can happen for no known reason but have links to:
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:
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 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:
If not treated, CSF rhinorrhea can lead to serious health problems, such as meningitis or other dangerous infections.
To diagnose a CSF leak, your doctor may ask you about symptoms you're having.
People with CSF leaks may have:
Other symptoms of a CSF leak include:
Some symptoms relate only to CSF rhinorrhea and a leak from the nose. These include:
CSF otorrhea, or a CSF leak into the ear, can lead to:
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:
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.
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:
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.