Possible complications of a cranial CSF leak that is left untreated include meningitis and air entering the spaces surrounding the brain (tension pneumocephalus). Abnormalities of the skull base or inner ear.Having a previous surgery on or around the skull.Risk factors for cranial CSF leaks include: Connective tissue disorders such as Marfan syndrome or Ehlers-Danlos syndrome.Having a previous surgery or procedure on or around the spine.Risk factors for spinal CSF leaks include: Sometimes a CSF leak doesn't have a known cause (spontaneous CSF leak). Sometimes CSF leaks develop after very minor events: Abnormal connections between dura mater and veins ( CSF-venous fistulas).Abnormalities of the dura mater around the nerve roots in the spine.An epidural in the spine for pain relief, such as during labor and delivery.Clear, watery drainage from the nose or ear (on one side).Other symptoms of spinal CSF leaks may include: Rarely, start suddenly ("thunderclap" headache). May start or worsen with exertion (such as coughing or straining).The most common symptom of a spinal CSF leak is headache. Symptoms vary between spinal and cranial CSF leaks. Many CSF leaks need a blood patch to cover the hole or surgery to repair the leak. Some CSF leaks may heal with conservative treatments such as bed rest. The most common symptom of a spinal CSF leak is a headache, while a cranial CSF leak causes symptoms such as clear fluid leaking from the nose or ear. A spinal CSF leak occurs anywhere in the spinal column. These are spinal CSF leaks and cranial CSF leaks. Complications, such as meningitis, can arise if the condition is inadequately addressed.There are two distinct types of CSF leaks with different symptoms, causes and treatments. This approach involves performing a craniotomy, a procedure in which a section of skull is temporarily removed, so that the neurosurgeon can access the brain and repair the leak.Īlthough surgery is rarely needed, a proper diagnosis and expert management of nonsurgical treatment are essential. Sometimes traditional open surgery is best for the patient and therefore performed instead. Using an endoscope, the surgeon repairs the CSF leak without making any visible incisions. Many patients are good candidates for endoscopic neurosurgery through the nose or mouth, which is a minimally invasive technique. If the condition does not heal without further intervention, surgery to repair the leak is necessary. If intracranial pressure is high, patients may have a lumbar drain placed in the lumbar area of the spine, allowing small amounts of CSF to drip out and preventing further injury to any damaged tissues. Medications such as pain relievers, steroids, or antibiotics may also be prescribed. The following tests may be performed to check CSF pressure and to confirm a CSF leak along the spine. Prepare for Your Visit Evaluation for CSF Leaks Duke neuroradiologists perform a physical exam and conduct a thorough medical history to obtain more information about your symptoms. Patients are simply instructed to get a week or two of bed rest and drink plenty of fluids, particularly caffeinated beverages because caffeine stimulates the production of CSF. CSF leak care is provided at Duke University Hospital. Our neurosurgeons take a conservative, noninvasive treatment approach first because most CSF conditions heal on their own without surgical intervention. This is a serious condition that can cause headaches. Collection and testing of clear fluid that drains from the nose with beta-trace protein assay to determine whether the fluid is CSF.Īt Columbia, our neurosurgeons use the most sophisticated surgical techniques to treat cerebrospinal fluid (CSF) conditions, providing the best possible prognosis. Summary A CSF leak occurs when cerebrospinal fluid (CSF) escapes from the protective layer surrounding the brain and spinal cord.Cisternogram, a test that requires the injection of radioactive material into the spinal canal in order to detect abnormal CSF flow in the central nervous system.This study is usually conducted with contrast enhancement to yield highly detailed images. Head or spine magnetic resonance imaging (MRI) to visualize tissue, blood vessels and other structures and also detect location of the leak.CT myelogram, a test in which a contrast enhancement is injected into the spinal canal and then the structures in the head and spine are imaged in great detail using CT scanning.Usually, contrast enhancement is administered during the scan for better visualization. Computed tomography (CT) scan of the head to view leak location and produce detailed images of skull anatomy and tissue.A combination of diagnostic tests is typically used to provide a diagnosis and also detect the location of the cerebrospinal fluid (CSF) condition.
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