Cerebrospinal Fluid Leak

Cerebrospinal fluid (CSF) is a colorless fluid that cushions the brain, protecting it from trauma and infections. Nasal CSF leaks are caused by small, sometimes microscopic breaks in the barrier between the brain and roof of the sinuses.

The diagnosis can be difficult to make because nasal drainage is also caused by allergies, sinusitis, and other inflammatory conditions. Causes of CSF leak include head injuries and prior head or sinus surgery.

Causes

Some leaks occur spontaneously without any trauma in patients with elevated intracranial pressure, termed idiopathic intracranial hypertension (IIH). This is a relatively rare condition with an average incidence of 0.001 perecent (1:100000).

Those most at risk are females between the ages of 20 and 45. Obesity is also a risk factor.

Symptoms

The most common symptoms of CSF leak include steady drip of clear fluid from the nose (typically just one side) and headaches.

The major risk of leaving a CSF leak unrepaired is a life-threatening infection of the lining of the brain called meningitis, which requires hospitalization and intravenous antibiotics to treat.

Diagnosis

Some patients have already had a recent prior episode of meningitis at the time of evaluation, which increases the suspicion of CSF leak even when the specific location is uncertain.

A complete evaluation including a medical history and examination are first performed. You may be asked to collect, if possible, a sample of the fluid in a sterile container to so it can be tested to confirm the leak.

A CT scan and/or MRI of the sinuses are often recommended to help identify the exact location of the defect responsible for the leak and assist with planning of the repair.

Treatment

The management of CSF leaks at UCI Health is a multidisciplinary approach between specialties. A neurosurgeon is consulted at the time of surgery to assist with  the insertion of a lumbar drain to decompress the CSF space.

In the majority of cases, no external incision is involved and the CSF leak can be managed using a minimally invasive, purely endoscopic approach through the nostrils. Image-guided surgical techniques are used to help identify the leak location.

Once the leak is identified, it is repaired using the patient’s own tissue, which is usually obtained from the nose. Typically, patients require a two to three day hospital stay.