Cerebrospinal Fluid Leaks
Cerebrospinal fluid (CSF) surrounds the brain and spine, and is encased in a membrane known as the "dura." Sometimes, a CSF leak develops from a tear in the dura, allowing CSF to leak from the nose or ear. CSF leaks can be caused by head injuries; certain types of brain, head and spinal surgeries; tube placement for pain medications or epidurals; or lumbar punctures (spinal taps). They can also develop spontaneously, although the majority are the result of surgery or lumbar puncture.
Symptoms of Cerebrospinal Fluid Leaks
Symptoms of a CSF leak include a watery, clear discharge from the nose, and a headache that is more painful when standing upright than when lying down. If accompanied by nausea, photosensitivity and a stiff neck, an infection may be present. If a CSF leak is not repaired, serious and potentially fatal complications, including meningitis or swelling of the brain, may arise.
Diagnosis of Cerebrospinal Fluid Leaks
Diagnosis is usually based on the patient's history of injury, surgery or lumbar puncture. Depending upon the patient's history, tests may include a CT scan, using contrast dye, of the head; a CT myelogram; an MRI scan of the head or spine; and a CSF radioisotope test to track the leakage.
Treatment of Cerebrospinal Fluid Leaks
Depending upon its cause, a CSF leak may resolve on its own. If not, there are surgical options; which one is used depends on the location and type of CSF leak.
To repair a CSF leak that occurs immediately after surgery, a lumbar drain is often used. To repair a CSF leak in the sinuses, endoscopic surgery is usually performed; the patient's tissue is used to create a plug that stops the leakage. To repair a CSF leak around the mastoid bone in the ear, bone may have to be removed, and the leak repaired using tissue, fat and a special type of glue. To repair a CSF leak behind the eardrum, or in the ear but closer toward the brain, craniotomy may be necessary; tissue placement and glue are used to close the leak. A lumbar drain may also be required in these instances.