CSF leaks or Cerebrospinal Fluid Leaks can be dangerous and potentially life-threatening. A CSF leak happens when the outermost layer of the membranes surrounding the spinal cord (dura mater) tears or breaks, allowing some of the fluid to escape.
This article addresses some of the most frequently asked questions about CSF leaks of the nose and or cranial CSF leak treatment. Keep reading to learn more.
What Are the Signs and Symptoms of CSF Leaks?
Clear, watery discharge from the nose is a classic indication of nasal CSF leak. In some cases, people may experience headaches when they sit up. The nasal discharge often has a salty flavor, but this may not always be the case.
What Are the Causes of CSF Leaks of the Nose?
CSF leak or runny nose can occur for a variety of reasons. Here are some of them:
- Injury to the head that damages the brain lining (called dura mater)
- Surgical hole in the skull next to your sinus cavities
- Spontaneous herniation of the brain lining from increased spinal fluid pressure (also called pseudotumor cerebri or idiopathic intracranial hypertension)
What Happens When a Sinus CSF Leak Occurs?
The brain floats in cerebrospinal fluid, surrounded by three protective layers of membrane. Ever heard of brain fluid leaking from nose? When a CSF leak occurs through a small defect in the skull, thin clear fluid will drain through the sinuses and into the nasal cavity. Sometimes, spontaneous CSF leaks may be large enough to cause significant enough drainage of brain fluid that the optimum pressure inside the cranium drops, leading to intracranial hypotention (low pressure).
In some cases, your brain could sink downward in your skull, thus exerting pressure on the brainstem, which can be life-threatening
How Are CSF Leaks Diagnosed?
A doctor will start by conducting a physical exam and listening to your medical history. Any history of head trauma, obesity, or sinonasal surgery are some of the factors that may indicate you are at risk for acerebrospinal fluid leak. You may also undergo certain tests and scans before they can provide a final diagnosis.
These are some of the tests used to diagnose a CSF leak:
- Diagnostic Nasal Endoscopy: This minor office procedure uses a small camera to look at areas of clear drainage or abnormalities, such as a herniation of the brain or it’s lining (encephalocele or meningocele).
- CT Scan of the Sinuses: This imaging study can evaluate for skull base bony defects or areas of opacification in the sinuses.
- MRI Scan of the Brain: This imaging study can evaluate for problems in the brain or areas of herniation of the brain or it’s linings into the sinus cavities.
- Myelography: This scan uses a contrast dye to detect the location of a CSF leak.
- Spinal Tap/Lumbar Puncture: During a spinal tap, your cerebrospinal fluid is withdrawn through a needle to check the pressure of CSF inside the spinal column. Occasionally a dye may be injected to be able to see the CSF more easily in the nose.
How Are CSF Leaks Treated?
Conservative therapies like bed rest, increased intake of water, and lying in bed with elevation of the head may be enough to treat some cases of CSF leaks.
However, your doctor may recommend other treatments, such as:
- Epidural Blood Patch: In cases of CSF leak from a lumbar puncture, a sample of your own blood is inserted into the spinal canal to form a blood clot over the CSF leak and patch it.
- Surgical Intervention: When no other treatment helps seal the CSF leak, your doctor might recommend a surgical procedure. Endoscopic CSF leak repair has a high success rate for CSF leaks of the nose.
Visit the SinusHealth website for more information on CSF leaks. Our board-certified otolaryngologists provide trusted answers to your questions. We seek to encourage excellent patient care by delivering the right information to you. Get in touch with us if you need help finding a rhinologist. If you have further doubts, feel free to contact us online!