CSF leak


Cerebrospinal fluid leak may occur from the nose, from the external auditory canal or from trauma, or operative abnormalities in the skull or spine.

A CSF leak is an escape of the fluid that surrounds the brain and spinal cord.

This fluid is called the cerebrospinal fluid (CSF).

The risk of a cerebrospinal fluid (CSF) leak is rare.

It is potentially devastating with severe morbidity and mortality implications.

Can occur in a wide range of procedural and surgical settings.

It is caused by any tear or hole in the membrane that surrounds the brain and spinal cord dura, and can allow the fluid that surrounds those organs to leak.

The pressure around the brain and spinal cord drops with leakage.

Causes of leakage through the dura include:

Certain head, brain, or spinal surgeries

Head injury

Placement of tubes for epidural anesthesia or pain medicines

Spinal tap

Spontaneous CSF leak.

Evaluation may include:

CT scan of the head with contrast dye

CT myelogram of the spine

MRI of the head or spine

Radioisotope test of the CSF to track the leakage

Treatment depends on the cause of the leak.

Symptoms may improve on their own after a few days of bed rest.

Increasing fluid intake, especially drinks with caffeine, can help slow or stop the leak and may help with headache pain.

CSF leak following a lumbar puncture lasting longer than a week after a lumbar puncture, a blood patch, because a blood clot can be used to seal the leak.

In most cases, a blood patch makes the symptoms go away.

In rare cases, surgery may be required to repair the tear in the dura and stop the headache.

In most cases spontaneous healing occurs with no lasting symptoms.

If the CSF leak recurs, high pressure of the CSF might be the cause and should be treated.

Possible complications of CSF leak include infections after surgery or trauma leading to meningitis.

Most CSF leaks are a complication of a spinal tap or surgery.

A spinal tap should be performed with the smallest needle possible.

Leaks result from a meningeal dural and arachnoid laceration with fistula formation.

Blunt trauma is the most common cause.

The absence of glucose in leaking fluid excludes CSF.

Beta-2-transferrin (B2Tr) is produced in the brain by neuraminidase activity and is present in the CSF, ocular aqueous humor and perilymph tissue.

B2Tr not present in sinus mucosal fluid or in tears.

Immunoelectrophoresis testing of fluid for B2Tr is a specific analysis for CSF.

Beta-trace protein, is prostaglandin D2 synthase, produced by epithelial cells of the choroids plexus and meninges and is found in the CSF, perilymph fluid, seminal fluid and urine.

Beta-trace is approximately 35 times more concentrated in CSF than in serum. immunoelectrophoresis of fluid for beta trace protein has high specificity and sensitivity for the detection of CSF.

From the nose is ref2242ed to as rhinorrhea.

Rhinorrhea caused by head trauma, sequelae of skull based surgery, such as sinus surgery, transphenoidal pituitary surgery, translabyrinthine acoustic schwanomas surgery, acoustic schwanomas and mastoid surgery with intact tympanic membrane, and destructive skull based lesions, including malignancies and empty sella, developmental abnormalities in the ethmoid, sphenoid, frontal and petrous temporal bones with formation of meningocele or meningoencephalocele and fractures of the petrous temporal bone or other processes in which CSF in the middle ear drains to the nose with intact tympanic membrane.

Rhinorrhea-fewer than 5% of cases are spontaneous.

Rhinorrhea-most cases begin soon after head injury and cease spontaneously within 7-180 days.

CSF otorrhea occurs with a perforated tympanic membrane with fractures of the petrous temporal bone, translabyrinthine or mastoid surgery, development defects of the petrous apex, meningeal laceration, trauma of the stapes, and cochlear abnormalities.

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