Learn more about CSF leakage and how it is treated.
Cerebrospinal fluid (CSF) protects the brain from infection and physical trauma. When a CSF leak occurs, fluid leaks through a small break in the barrier separating the brain and the sinuses. The leak results in fluid leaking from the nasal cavity. It can be difficult to diagnose a CSF leak since the clear fluid is often mistaken for typical nasal drainage due to sinus conditions or allergies.
- The fluid can drain from the nose or ears, depending on where the hole in the skull develops
- The fluid can drain from the nose or ears, depending on where the hole in the skull develops
- Traumatic CSF leaks will generally heal on their own but spontaneous CSF leaks will rarely heal on their own and require surgery.
What Causes CSF Leakage
A hole or tear that allows fluid to leak from the membrane around the spinal cord (dura) and brain can result in fluid leaking, which then causes pressure around the spinal cord and brain to decrease. Common causes of CSF leakage are traumatic head injuries (traumatic CSF leaks), spinal taps (lumbar punctures), or surgery. Some patients develop cerebrospinal fluid leaks spontaneously or because of brain tumor resection. Symptoms experienced with a CSF leak may include:
- Headaches that become worse when sitting up and better when lying down
- Clear, watery drainage of CSF fluid through the nose or ear (after tube placement)
How Are CSF Leaks Diagnosed?
A CSF leak is more likely to be suspected in patients who have had a recent meningitis infection since such infections may be related to cerebrospinal fluid leakage. In addition to a physical exam and a review of a patient’s reported symptoms and medical history, diagnosis of CSF leakage often involves a CT scan of the head performed. The nose may be examined with an endoscope. Patients may be asked to lean forward to see if drainage is produced. Other tests performed sometimes include:
- MRIs or CT scans of the sinuses to identify where the leak is located
- CT myelogram of the spine
Treatment Options for CSF Leakage
It is not unusual for post-traumatic CSF leak patients to respond well to bed rest for a few weeks and other conservative (non-surgical) treatment recommendations. During this time, patients will be urged to avoid coughing and sneezing as much as possible. Heavy lifting should also be avoided. Stool softeners are sometimes recommended to further minimize any type of straining that may inhibit natural healing.
Surgical repairs are typically made with tissue taken from inside of a patient’s muscle covering (fascia). Usually multiple layers are used for achieving closure.
In some cases, there is no cause or contributing factor for a CSF leak. When this happens, it is referred to as a spontaneous CSF leak. Spontaneous CSF leak is usually caused by idiopathic intracranial hypertension. The outlook for patients with cerebrospinal fluid leakage is usually good. In rare instances, high pressure of the CSF (hydrocephalus) causes a leak to return after it has been treated. Since headaches are the most common symptom of CSF leaks, persistent headaches that include nose or ear fluid drainage should be evaluated by a doctor. CSF leaks that aren’t treated may result in a potentially life-threatening infection of the lining of the brain (meningitis).