Cerebrospinal Fluid (CSF) Leak

What You Need to Know

  • Cerebrospinal fluid (CSF) is a watery liquid that continually circulates through the brain'due south ventricles (hollow cavities) and around the surface of the brain and spinal string.
  • CSF washes out impurities from the brain, transfers nutrients and provides protective cushioning to the brain and spinal cord.
  • The fluid is independent by the meninges, a serial of protective membranes that surround the brain and spinal string.
  • CSF leaks tin cause 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 finer to prevent meningitis, an infection of the meninges.

What is cerebrospinal fluid?

Cerebrospinal fluid (CSF) is a articulate liquid that surrounds the brain and spinal cord. It provides a cushion for delicate brain and spinal tissue. Reduced cerebrospinal fluid, as in the example of a leak, requires immediate care past a trained expert.

What is a CSF leak?

A CSF leak is when the CSF escapes through a tear or pigsty in the dura, the outermost layer of the meninges, which surround the brain. The dura can exist injured or punctured during a caput injury or a surgical process involving the sinuses, brain or spine. Information technology may besides be damaged by a lumbar puncture, including a spinal tap, spinal anesthesia or myelogram. Spontaneous CSF leaks can occur due to increased intracranial pressure level (pressure in the head). This 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 belch 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 following tests.

  • Analysis of the nasal fluid: This examination is used to detect beta-two transferrin, a poly peptide constitute most exclusively in CSF.
  • CT  scan: This noninvasive diagnostic imaging procedure uses X-rays and figurer engineering to produce detailed imaging of bones and planes of the encephalon.
  • MRIscan: This uses a large magnet, radiofrequencies and a figurer to produce detailed images of organs and structures in the body. MRI scans tin can help determine the location and severity of a CSF leak.browse: This uses a large magnet, radiofrequencies and a calculator to produce detailed images of organs and structures in the body. MRI scans can help determine the location and severity of a CSF leak.
  • Cisternogram — CT or nuclear medicine : These two tests, each performed in a similar way, crave a spinal tap (likewise known every bit a lumbar puncture) to administer a fluid to the CSF that allows your doctor to place if a CSF leak is nowadays and the source of the leak.
    • ACT cisternogram may assistance identify the site of a CSF leak into the nasal cavities or mastoid bone. During this examination, a contrast medium is injected into the spinal fluid through a spinal tap, and then a CT scan is performed.
    • A pledget report tin can ostend whether CSF is leaking into the nose or mastoid from a suspension in the bone at the base of the skull. During this exam, a radioactive tracer is injected into the spinal fluid through a spinal tap. Pledgets (small-scale cotton wool pads) are inserted into the olfactory organ for several hours to collect fluid and are later checked for the presence of the radionuclide.
  • During amyelogram browse, a contrasting substance is injected into the spinal string, and MRI or CT scans are used to look for tears or ruptures in the dura.

CSF Leak Handling

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

Nasal CSF Leak

Surgery for endoscopic nasal CSF leak closure, which is performed entirely through the nostrils, does not require cutting through the skin. The CSF leak is repaired using your own tissue from the nose 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 later surgery. Some patients may require a lumbar drain that is removed before going habitation.

Ear CSF Leak

Ear CSF leak closure requires cutting the skin behind the ear and removing portions of mastoid (honeycomb-similar, bony tissue) to access the source of the CSF leak around the ear. Using your own 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, at that place are other treatments, such as use of blood or fibrin patches. For these procedures, the medico uses CT guidance to inject a small amount of the patient'due south ain claret or a plug of fibrin (the fibrous protein in claret that helps it clot) into the spinal culvert. This can frequently repair the leak. If these methods fail, duraplasty — surgical repair of the dura — may be 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 ascent pressures, peculiarly in postsurgical patients.