Cerebrospinal Fluid (CSF) Leak

What You Need to Know

  • Cerebrospinal fluid (CSF) is a watery liquid that continually circulates through the encephalon'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 string.
  • The fluid is independent by the meninges, a serial of protective membranes that surround the brain and spinal cord.
  • CSF leaks can cause fluid to leak through the ears, through the nose or into the spinal canal.
  • CSF leakage through the ears or olfactory organ should exist diagnosed and treated chop-chop and effectively to prevent meningitis, an infection of the meninges.

What is cerebrospinal fluid?

Cerebrospinal fluid (CSF) is a clear liquid that surrounds the encephalon and spinal string. Information technology provides a absorber for delicate brain and spinal tissue. Reduced cerebrospinal fluid, as in the instance of a leak, requires immediate intendance past a trained good.

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 caput injury or a surgical process involving the sinuses, brain or spine. Information technology may also exist damaged by a lumbar puncture, including a spinal tap, spinal anesthesia or myelogram. Spontaneous CSF leaks can occur due to increased intracranial pressure (pressure level in the head). This tin happen to patients with hydrocephalus, a buildup of CSF in the skull.  Spontaneous leaks may also 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 exist difficult to distinguish from normal nasal discharge without testing)
  • Tinnitus (ringing in the ears)
  • Visual disturbances

Diagnosis of a CSF Leak

If your medico suspects a CSF leak, he or she may recommend the following tests.

  • Analysis of the nasal fluid: This exam is used to notice beta-ii transferrin, a protein found almost exclusively in CSF.
  • CT  scan: This noninvasive diagnostic imaging process uses 10-rays and figurer engineering to produce detailed imaging of basic and planes of the brain.
  • MRIscan: This uses a large magnet, radiofrequencies and a calculator to produce detailed images of organs and structures in the body. MRI scans can assist make up one's mind the location and severity of a CSF leak.scan: This uses a large magnet, radiofrequencies and a computer to produce detailed images of organs and structures in the body. MRI scans can aid determine the location and severity of a CSF leak.
  • Cisternogram — CT or nuclear medicine : These 2 tests, each performed in a similar way, require a spinal tap (also known as a lumbar puncture) to administer a fluid to the CSF that allows your doctor to identify 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 can confirm whether CSF is leaking into the nose or mastoid from a break in the os at the base of operations of the skull. During this test, a radioactive tracer is injected into the spinal fluid through a spinal tap. Pledgets (small-scale cotton pads) are inserted into the nose for several hours to collect fluid and are later 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 expect for tears or ruptures in the dura.

CSF Leak Treatment

A CSF leak is a very serious status, and patients who take tears in their dura with persistent CSF leaks need repair as soon as possible to reduce headache pain 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 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 on surgery. Some patients may require a lumbar drain that is removed before going home.

Ear CSF Leak

Ear CSF leak closure requires cutting the skin behind the ear and removing portions of mastoid (honeycomb-like, 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 culvert, there are other treatments, such as utilize of blood or fibrin patches. For these procedures, the medico uses CT guidance to inject a small amount of the patient's own blood or a plug of fibrin (the fibrous protein in blood that helps it clot) into the spinal culvert. This can often repair the leak. If these methods neglect, 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 ascent intracranial pressure may help create leaks. Now, a multidisciplinary team is developing protocols to meliorate monitor ascension pressures, peculiarly in postsurgical patients.