What is Cerebrospinal Fluid (CSF)?
Cerebrospinal fluid is a liquid that continuously flows through the brain’s hollow chambers and around the surface of the brain and spinal cord. This liquid washes out pollutants from the brain, transmits nutrients and provides protective padding to the brain and the spinal cord. The cerebrospinal fluid is contained by the meninges, which are a series of safeguarding membranes that encloses the brain and spinal cord.
This article talks about how CSF Leak Repair can be done using CSF Leak surgery.
Image courtesy – Wikimedia
What is a CSF leak?
The brain is wholly wrapped with a lining called dura. The brain and the dura are situated partially above the nose and the sinuses, which are divided from them by a thin bone. Any form of rupture in the bone and the dura can lead to a CSF leak. This can trigger the fluids to leak through the ears or nose respectively or into the spinal canal.
A CSF leak becomes evident when clear fluid starts flowing from the nose or into the back of the throat. It can arise as a result of a head injury, complication from sinus or brain injury or due to tumor removal from the inside of a sinus. CSF leakage through the ears or nose need to be detected and treated promptly to prevent meningitis, an infection of the meninges.
Types of CSF leaks
There are two definite types of CSF leaks:
It occurs when CSF starts leaking out from around the spine due to a hole in the dura. This hole can occur as a result of :
1. A tear in the bone spur
2. An abnormal link with a nearby vein
3. A bodily injury
The most common symptom of a CSF leak is headache.
When a region of the skull gets damaged or cracks, the dura is exposed and it can easily tear leading to a cranial CSF leak. Its most common signs are chronic headaches and clear liquid drainage especially from one side of the nose or ear.
What are the symptoms of a CSF leak?
The symptoms of a CSF leak can be of two distinct types namely spinal and cranial. On the basis of this the symptoms can be listed as:
Symptoms of Spinal CSF leaks –
- Headaches
- Neck or shoulder ache
- Tinnitus (ringing in the ears)
- Changes in hearing
- Dizziness
- Nausea or vomiting
- Changes in vision
- Changes in cognition or behavior
Symptoms of Cranial CSF leaks –
- Clear liquid discharge from the nose or ear (on one side)
- Hearing impairment
- Metallic taste in the mouth
- Meningitis
What are the probable symptoms that happen with or because of a CSF leak?
The probable signals that happen with or because of a CSF leak can be summed up as:
- Lost sense of smell (anosmia)
- Indistinct or double vision (diplopia)
- Changes in hearing
- Hearing loss
- Pulsatile tinnitus (sounds from inside the ear)
- Seizures
- Neck pain and stiffness
- Lack of appetite
- Headaches
- Dizziness or vertigo
- Nausea and vomiting
- Photophobia
- Balance and gait problems
What are the trivial events that can lead to CSF leaks?
The trivial events that can lead to CSF leaks can be listed as follows:
- Sneezing
- Coughing
- Exerting to have a bowel movement
- Lifting heavy objects
- Falling
- Stretching
- Exercising
Causes, diagnosis and conservative treatment for CSF leaks
The causes of a CSF leak can be summed up as:
Causes of Spinal CSF leaks –
- Lumbar puncture
- An epidural in the spine to ease pain (such as during labor and delivery)
- Traumatic injury to the head or spine
- Bone spurs along the spine
- Abnormalities of the dura around the nerve roots in the spine
- Abnormal link between the dura mater and its nearby veins
- Previous surgery on the spine
Causes of Cranial CSF leaks –
- Head injury
- Increased pressure in the brain
- Poorly functioning shunt
- Abnormalities of the inner ear
The tests which are recommended by an ENT specialist to diagnose CSF leaks can be categorized as –
Diagnosis for Spinal CSF leaks –
- MRI with gadolinium
- Radioisotope cisternography (CT cisternography)
- Sending the nose / ear fluid discharge for Beta 2 transferrin test (lab investigation)
- Myelography
- Spinal tap (lumbar puncture)
Diagnosis for Cranial CSF leaks –
- MRI with gadolinium
- Tympanometry
- CT myelography
The conservative treatments for CSF leaks include:
- Complete bed rest with head elevated around 30 degrees
- Abstaining from sneezing or nose blowing
- Using stool softeners to prevent from straining
- Consuming over-the-counter or prescribed pain relief medications
- Taking acetazolamide (diuretics) in case of intracranial pressure
When to visit a doctor for CSF leak repair?
Consult a doctor if:
- One has constant runny nose
- One has discharge from the ears
- One has headache that aggravates when the head is upright
- One has a head injury
- One had a recent epidural
- One had a brain surgery
- One had a spinal cord surgery
Some CSF leaks may cure with conservative treatments but many leaks require surgery to repair the leak.
Consult Dr G V K Chaitanya Rao – Best ENT Doctor in Hyderabad.
When will an ENT specialist suggest a CSF leak repair surgery?
An ENT specialist will suggest a surgery only if:
- A CSF Leak that does not improve with conservative treatment
- A severe CSF Leak that is unlikely to heal on its own
- Blood clotting in the brain or spinal cord
- Herniated brain tissue that pushes into the ears or nose
- Meningitis
Risks and precautions
The risk factors related to CSF leak repair includes:
Risk factors of Spinal CSF leak –
- Having a prior surgery on or around the spine area
- Suffering from connective tissue disorders (such as Masfan syndrome or Ehler-Danlos syndrome)
Risk factors of Cranial CSF leak –
- Having a prior surgery on or around the skull area
- Obesity
- Obstructive sleep apnea
- Traumatic head injury
- Tumor at the base of the skull
- Malformation of the skull base or inner ear
Post a CSF leak repair surgery, one must take the following precautions:
- Sleep with head slightly elevated for first seven days
- No heavy weight lifting, bending over or exertion for 30 days
- Avoid blowing nose or sniffing forcefully
- Try sneezing with an open mouth if possible
- Wipe nose softly
- Take proper pain medication
- Use nasal sprays as prescribed by the doctor
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