Cerebrospinal Fluid (CSF) Leak

UT Southwestern Medical Center provides rapid diagnosis of cerebrospinal fluid leaks and offers the latest surgical and minimally invasive techniques to treat this dangerous condition. 

Neurosurgery services at UT Southwestern combine the talents of world-renowned surgeons with those of nonsurgical experts and researchers. We’re ranked as the top neurosurgery program in North Texas.

Rapid Treatment for a Full Recovery

A cerebrospinal fluid (CSF) leak is a condition in which the protective fluid surrounding the brain – the CSF – leaks into the sinuses or the ears.

Normally the brain is a sterile compartment that is separated from the sinuses and the ears by a bony separation called the skull base. CSF surrounds the brain and cushions it. A thick, leathery tissue called dura lines the inside of the skull, providing a seal that prevents spinal fluid from escaping. CSF leaks occur when there is a breakdown in this barrier.

The dura can be damaged by certain surgeries, head trauma, and tumors. Leaks sometimes occur spontaneously. Untreated CSF leaks can lead to life-threatening meningitis, brain infections, or stroke. 

UT Southwestern specialists offer rapid, accurate diagnosis of this dangerous condition, world-class surgical services to correct it, and pre- and post-surgical care that optimizes each patient’s treatment and recovery.

Symptoms

Symptoms of a CSF leak typically include:

• A headache that worsens upon sitting up and eases upon lying down
  
• Clear drainage from the ear (CSF otorrhea) or the nose (CSF rhinorrhea) when leaning forward or straining
  

Diagnosis

UT Southwestern physicians might use a variety of tests to diagnose a CSF leak and accurately pinpoint its location. 

Tests include:

• Magnetic resonance imaging (MRI) or computed tomography (CT) scans
  
• Nasal endoscopy
  
• Testing of nasal secretions 

Treatments for Cerebrospinal Fluid (CSF) Leak

The treatment of CSF leaks depends on the location of the leak. Leaks into the sinuses can usually be repaired through minimally invasive, endoscopic procedures. CSF leaks from the ear typically require open surgery. 

Endoscopic repair of CSF rhinorrhea (drainage from the nose)

In this procedure, the physician accesses the leak through the patient’s nose, avoiding an external incision. After the location of the leak has been precisely located, small pieces of tissue from the nasal lining are placed on the site. 

The success rate of this minimally invasive procedure is 90 to 95 percent; it carries far less risk than an open approach. But as with any surgical procedure, endoscopic sinus surgery does have certain risks, such as:

• Bleeding, scarring, or infection
  
• Change in smell or taste
  
• Injury to the eye (loss of vision, temporary or prolonged double vision, or eye tearing)
  
• Infection spreading to the brain, resulting in meningitis 

Repair of CSF otorrhea (drainage from the ear)

A CSF leak into the ear requires traditional surgical incisions. The surgical option depends on the location of the leak. If the leak is in the posterior fossa – toward the back of the skull – an outpatient surgery can usually correct the problem. A leak near the middle cranial fossa – near the center of the skull – requires a craniotomy, for which the patient will need to spend three to four days in the hospital.

Rehabilitation

Each patient’s recovery plan is tailored 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.