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
With proper treatment, CSF leaks usually heal without surgery
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 because of brain tumors or when tubes are placed for epidural anesthesia during childbirth. Symptoms experienced with a CSF leak may include:
Headaches that become worse when sitting up and better when lying down
Headaches associated with light sensitivity
Clear, watery drainage of CSF fluid through the nose or ear
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 with a contrast dye to allow any leaks to show up better. The nose may be examined with a tube with a light and tiny camera (endoscope). Patients may be asked to lean forward to see if drainage is produced. A lumbar puncture (spinal tap) may also be done to remove a sample of cerebrospinal fluid. Other tests performed sometimes include:
MRIs or CT scans of the sinuses to identify where the leak is located
CT myelogram of the spine
Radioisotope test to track fluid leakage
Treatment Options for CSF Leakage
It’s not unusual for some 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.
Pain relievers may be recommended to minimize headache symptoms. Drinking more fluids, especially beverages that are caffeinated, sometimes helps manage headaches and may stop the leak. A patient may be referred to a neurosurgeon for the insertion of a lumbar drain to decompress the CSF fluid space. The purpose of a lumbar drain is to decrease pressure from CSF leakage in the affected area enough to allow the hole to heal on its own.
A blood patch is sometimes done to allow a blood clot to form and seal the leak. Antibiotics are used to treat CSF leaks that include symptoms such as fever, chills, or unexplained changes in mental status indicating an infection. Defects responsible for the leakage are often corrected with endoscopic procedures. Surgery of this nature is done through the nose with a special instrument that allows the doctor to find the specific location of the leak so it can be repaired.
Surgical repairs are typically made with tissue taken from inside of a patient’s nose. Synthetic (man made) graft material can also be used. Nasal packing is placed in the nose following surgery via the nose and removed about a week later. It’s usually only when conservative treatment attempts fail that surgery is recommended for CSF leakage.
In some cases, there is no cause or contributing factor for a CSF leak. When this happens, it’s referred to as a spontaneous CSF leak (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).