Cerebrospinal fluid (CSF) surrounds the spine and brain, acting mainly as a protective cushion. A tear in one of the membranes containing the CSF allows the fluid to leak out. It can leak out through the nose, ears, or from a head or spinal wound. As the fluid drains, its cushioning power decreases, and the brain begins to rest directly on the skull. The result is headaches that worsen upon sitting or standing.
CSF leaks can be caused by a trauma to the head or spine, surgery, tumors, or increased pressure in the brain from conditions such as hydrocephalus. Spontaneous CSF leaks are associated with developmental defects of the skull bones that cause the meninges (membranes) to protrude. An opening in the membranes makes the nervous system more susceptible to infection. When left untreated, 25 to 50 percent of CSF leaks lead to meningitis.
The preferred surgical treatment at UPMC for cerebrospinal fluid leaks of the skull base is the Endoscopic Endonasal Approach (EEA). This innovative, minimally invasive technique uses the nose and nasal cavities as natural corridors to access hard-to-reach areas or previously inoperable tumors. EEA offers the benefits of no incisions to heal, no disfigurement to the patient, and a faster recovery time.
Your doctor may ask you about any symptoms that you are experiencing. The characteristic symptom is orthostatic headache, which is a headache that worsens when the patient is in the upright position and that is alleviated when the patient lies down. Drainage from the nose (rhinorrhea), ear (otorrhea), or surgical wound may also be present.
If the patient has drainage, a sample may be collected and tested. If it contains beta-2-transferrin, a protein specific to CSF, a positive diagnosis can be made.
Imaging studies including CT and MRI scans, cintilography, and cisternography may be performed to confirm the diagnosis and locate the leak.
Many CSF leaks repair themselves within a week to six months, especially those that have a traumatic origin. The patient may be instructed to rest and be given pain relievers for the headache. If leakage persists, an epidural blood patch may be injected at the site of the leak to block it.
Surgery
Surgery is needed in some cases, including repair to spontaneous leaks and most of the traumatic leaks involving skull base defects, which require repair of the bone and the meningeal tear.
If surgery is necessary, UPMC physicians will use the Endoscopic Endonasal Approach (EEA) to repair CSF leaks of the skull base. This approach allows surgeons to see and repair the leak without making an open incision. The procedure is performed through the nose and nasal cavities, and recovery time is faster than with a traditional approach. A lumbar drain may also be necessary in certain cases.
