Cerebrospinal Fluid (CSF) Leak

What You Need to Know

  • Cerebrospinal fluid (CSF) is a watery liquid that continually circulates through the brain's ventricles (hollow cavities) and around the surface of the brain and spinal cord.
  • CSF washes out impurities from the brain, transfers nutrients and provides protective cushioning to the brain and spinal cord.
  • The fluid is contained past the meninges, a serial of protective membranes that surround the brain and spinal cord.
  • CSF leaks can crusade fluid to leak through the ears, through the nose or into the spinal canal.
  • CSF leakage through the ears or nose should be diagnosed and treated quickly and effectively to forestall meningitis, an infection of the meninges.

What is cerebrospinal fluid?

Cerebrospinal fluid (CSF) is a clear liquid that surrounds the brain and spinal string. It provides a absorber for frail brain and spinal tissue. Reduced cerebrospinal fluid, as in the instance of a leak, requires immediate intendance by a trained expert.

What is a CSF leak?

A CSF leak is when the CSF escapes through a tear or hole in the dura, the outermost layer of the meninges, which surround the brain. The dura can be injured or punctured during a head injury or a surgical procedure involving the sinuses, encephalon or spine. Information technology may also be damaged past a lumbar puncture, including a spinal tap, spinal anesthesia or myelogram. Spontaneous CSF leaks can occur due to increased intracranial pressure (pressure in the head). This tin can happen to patients with hydrocephalus, a buildup of CSF in the skull.  Spontaneous leaks may likewise occur without an identifiable cause.

CSF Leak Symptoms

Symptoms of a CSF leak include:

  • Headache
  • Meningitis (bacterial or viral)
  • Nasal drainage of CSF (this may be difficult to distinguish from normal nasal discharge without testing)
  • Tinnitus (ringing in the ears)
  • Visual disturbances

Diagnosis of a CSF Leak

If your doctor suspects a CSF leak, he or she may recommend the post-obit tests.

  • Analysis of the nasal fluid: This test is used to discover beta-2 transferrin, a protein establish almost exclusively in CSF.
  • CT  browse: This noninvasive diagnostic imaging procedure uses X-rays and calculator applied science to produce detailed imaging of basic and planes of the brain.
  • MRIscan: This uses a large magnet, radiofrequencies and a computer to produce detailed images of organs and structures in the body. MRI scans can assist determine the location and severity of a CSF leak.scan: This uses a large magnet, radiofrequencies and a reckoner to produce detailed images of organs and structures in the trunk. MRI scans can assistance determine the location and severity of a CSF leak.
  • Cisternogram — CT or nuclear medicine : These two tests, each performed in a similar manner, require a spinal tap (besides known as a lumbar puncture) to administer a fluid to the CSF that allows your md to place if a CSF leak is present and the source of the leak.
    • ACT cisternogram may help place the site of a CSF leak into the nasal cavities or mastoid bone. During this test, a contrast medium is injected into the spinal fluid through a spinal tap, and then a CT scan is performed.
    • A pledget study tin confirm whether CSF is leaking into the nose or mastoid from a break in the bone at the base of the skull. During this test, a radioactive tracer is injected into the spinal fluid through a spinal tap. Pledgets (modest cotton pads) are inserted into the nose for several hours to collect fluid and are afterwards checked for the presence of the radionuclide.
  • During amyelogram scan, a contrasting substance is injected into the spinal cord, and MRI or CT scans are used to look for tears or ruptures in the dura.

CSF Leak Treatment

A CSF leak is a very serious condition, and patients who have tears in their dura with persistent CSF leaks need repair as soon as possible to reduce headache hurting and the chance of meningitis.

Nasal CSF Leak

Surgery for endoscopic nasal CSF leak closure, which is performed entirely through the nostrils, does not require cut through the pare. The CSF leak is repaired using your ain tissue from the olfactory organ or with a biomaterial graft. Length of stay in the hospital depends on the size of the leak — most patients are in the hospital for a few days afterward surgery. Some patients may require a lumbar bleed that is removed before going home.

Ear CSF Leak

Ear CSF leak closure requires cutting the skin backside the ear and removing portions of mastoid (honeycomb-like, bony tissue) to access the source of the CSF leak around the ear. Using your ain tissue or a biomaterial graft, the surgeon repairs the leak and seals the surgical opening.

Spinal CSF Leak

For CSF leaks that drain into the spinal canal, there are other treatments, such every bit use of blood or fibrin patches. For these procedures, the physician uses CT guidance to inject a small amount of the patient'due south own claret or a plug of fibrin (the fibrous protein in blood that helps information technology clot) into the spinal canal. This tin can often repair the leak. If these methods neglect, duraplasty — surgical repair of the dura — may exist necessary.

Dr. Lane with patient

A Multidisciplinary Approach to Treating Spontaneous CSF Leaks

Physicians have long known that rising intracranial pressure may help create leaks. Now, a multidisciplinary team is developing protocols to better monitor rising pressures, specially in postsurgical patients.