What is a Cerebrospinal Fluid (CSF) Leak?

Cerebrospinal fluid is a clear mixture of electrolytes and water that circulates the brain and spinal cord that provides basic cushioning and protection to these structures. A disruption to the lining of the brain, or in the bone that separates the brain from the sinus structures, can result in cerebrospinal fluid draining into the nose or ear. This is known as a Cerebrospinal Fluid Leak (CSF).

There are two different types of Cerebrospinal Fluid leaks: spontaneous and traumatic leaks. Spontaneous leaks occur without a known cause, and traumatic leaks occur typically after a head injury, tumor, or surgery.

A CSF leak is very dangerous and potentially life-threatening as it can lead to meningitis. For a condition as serious as a CSF leak, you should consult with a sinus specialist immediately to begin the proper treatment.

What Are the Symptoms of a CSF Leak?

The most common symptom of a CSF leak is clear, watery drainage leaking from only one side of the nose or one ear, that has a salty taste. Many times this drainage will increase when a patient tilts his or her head forward, or when a patient gets up after lying down. Additional symptoms include changes in vision or hearing, neck stiffness, and chronic sever headaches.

What Causes a Cerebrospinal Fluid Leak?

To understand the causes of a leak, it’s important to understand how cerebrospinal fluid works. CSF is mostly stored in the choroid plexus (a small area within the brain) and is continuously replenished. It circles the brain and spine to provide immunological and mechanical protection to ensure proper function of these very important structures.

A CSF leak can be caused by a few different things. Some cerebrospinal fluid leak patients experience elevated intracranial pressure which, over time, causes the connective bone between the sinuses and the brain to become thinner, ultimately leading to a CSF leak. Other patients may experience a CSF leak after a traumatic injury such as hitting his or her head or face, which causes a fracture of the connective bone between the brain and sinuses. In some very rare cases, other patients may have a cerebrospinal fluid leak if an inexperienced surgeon has accidentally penetrated through the sinus bones while operating.

How is a CSF Leak Diagnosed and Treated?

A CSF leak is a very dangerous problem, so if you believe you have a CSF leak or are experiencing any of the symptoms, it’s important to consult with a rhinologist immediately to create a treatment plan.

To diagnose a cerebrospinal fluid leak, a rhinologist like Dr. Kuperan collects and tests the nasal drainage to see if it contains beta-2 transferrin, a protein unique to CSF. A CT scan of the sinuses and a nasal endoscopy (using a camera to look inside the nose) may also be used to better asses the problem.

A small cerebrospinal fluid leak may be treated by placing a lumbar spinal drain to decrease the intracranial pressure. If this works, the CSF leak will spontaneously resolve. Patients who don’t experience relief after a lumbar drain may require surgery. Before a CSF leak repair is performed surgically, a rhinologist determines the location of the leak by injecting a dye into the CSF space that turns the fluid into a yellow/green color. Once the location of the CSF leak is determined, a rhinologist can close the leak by performing a highly-specialized CSF leak repair.

Every single patient is different and experiences symptoms as such. At Houston Advanced Nose & Sinus, we offer unique approaches to each patient to resolve CSF leaks as efficiently as possible.