Cerebrospinal Fluid Leak

At UT Southwestern Medical Center, patients can expect an accurate diagnosis for cerebrospinal fluid (CSF) leaks as well as access to the newest surgical and minimally invasive treatments for this potentially life-threatening condition.

The otolaryngology services offered at UT Southwestern bring together the expertise of accomplished surgeons and nonsurgical specialists as well as researchers to offer comprehensive care.

Prompt Care for Cerebrospinal Fluid (CSF) Leaks

A CSF leak of the skull base is a condition in which the clear fluid that surrounds and cushions the brain leaks out of the skull through a defect or hole in the base of the skull. If left untreated, a CSF leak can cause serious complications, such as meningitis.

A CSF leak in the skull base can be caused by a traumatic injury, a spontaneous defect in the skull, or a previous surgical procedure. Treatment for a CSF leak of the skull base usually requires surgery.

Home to a world-renowned neurological surgery center and state-of-the-art neurological intensive care unit, UT Southwestern has the resources to treat complex skull base conditions. Our multidisciplinary team uses the most advanced techniques and technologies to help evaluate and treat CSF leaks quickly and accurately.

Causes of CSF Leaks

Although trauma, surgery, and tumors can cause CSF leaks, they most commonly occur without any history of these risk factors.

Without a history of these risk factors, the leak is considered idiopathic, which means there is no known cause for the leak. However, CSF leaks are more common in patients with:

• Obesity
• Chronically elevated CSF pressure
• Obstructive sleep apnea

UT Southwestern physicians review these risk factors with patients and refer them to the appropriate specialist.

CSF Leak Symptoms

A patient with a CSF leak may have fluid in the ear or clear fluid draining from the ear or nose. Other symptoms include:

• Headache
• Hearing loss
• Nasal congestion
• Ear fullness

Surgical Treatments for a CSF leak

CSF leaks through the ear can be treated through a mastoidectomy or a craniotomy.

A mastoidectomy is a surgical procedure performed on the mastoid bone, which is located just behind the ear. The procedure allows access to many defects where the leak might be coming from. The surgeon will use tissue or artificial bone cement to repair the leak.

The surgery is typically performed under general anesthesia and can be done as an outpatient procedure or with an overnight stay in the hospital.

Some leaks are not accessible through a mastoidectomy, in which case a craniotomy will need to be performed. This involves the surgical removal of part of the skull bone to access the brain and is likewise usually performed under general anesthesia; however, a craniotomy requires an overnight stay in the intensive care unit (ICU) and a total hospital stay of two to three days.

CSF leaks through the nose can generally be repaired through the nose without any external incision. Rarely, a craniotomy is needed to repair a large leak or a leak in a place that is not accessible through the nose.

Our doctors will discuss the pros and cons of the approaches, which approach they recommend, and the risks associated with each option.

CSF Leak Rehabilitation

Each patient’s recovery plan is tailored to the patient to ensure the surgery is successful and the recovery is complete.

Patients who require traditional surgery will recover in the Neuroscience Intensive Care Unit (Neuro ICU) at UT Southwestern, one of the world’s premier neurological diagnostic and treatment centers.

Postoperatively, patients are placed on bed rest in the hospital, typically for two to three days, to help facilitate the healing process and closely monitor for leak recurrence.

The repair site can take four to six weeks to heal completely. During that time, the patient’s activity will be restricted to avoid straining, heavy lifting (no greater than 10 pounds), and nose blowing.

Postsurgical care

After recovering from surgery, patients might be asked to see specialists to look for causes of the CSF leak in order to prevent a new leak in the future.