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Cerebrospinal fluid also called CSF (spinal or brain fluid) is a clear liquid that surrounds the delicate structures of the brain and spinal cord. It protects the brain and spinal cord from the surrounding bone. Adults have about 200 ml (or one cup) of CSF circulating in their body at any given time. CSF leaks can be caused by surgery, trauma, tumors or be spontaneous. They can cause headaches or a clear drainage from the nose and can potentially become infected. They are treated by a range of monitoring until they close or surgery to repair the barrier to the brain. Any procedure to prevent CSF from leaking from the skull or skull base is termed CSF leak surgery.
Diagnosis of a CSF leak is based on a combination of a patient’s history and some diagnostic studies including lab work and imaging. Fluid collected from the nose may show a protein called beta-2-transferrin that confirms a CSF leak. These imaging studies including CT (Computed Tomography) scans and MRI (Magnetic Resonance Imaging) Scans may show CSF leaks. CT scans give details of the bony anatomy of the brain and can demonstrate any weaknesses or defects of the skull bone. MRI scans image the soft tissue of the brain and nasal sinuses and gives valuable information about other underlying processes that may be causing the CSF leak. Some CSF leaks may resolve on their own or with conservative treatment. If not, they may require surgery to correct.
Conservative methods are designed to reduce the amount of pressure in the brain allowing for the tissue to heal and the leak to resolve on its own. This may include bedrest, medications and a lumbar drain.
Surgery is used for acute CSF leaks or for patients who have failed conservative management. CSF leaks can be repaired with minimally invasive techniques using nasal endoscopes. Using state of the art technology, three dimensional image guidance is utilized to identify the source of the leak. Mucosal tissue, fat or larger flaps are then harvested and used as a barrier to stop the drainage. The surgeon may then place tissue sealant in the area of the leak to further support the closure. Surgery may also be used in combination with some conservative techniques to further facilitate closure and resolution of the leak.
The surgeons of Norelle Health are highly trained and skilled in the diagnosis, management, and treatment of CSF leaks. Our combination of Neurosurgeons, Sinus Surgeons, and Head and Neck Surgeons provide the optimal range of treatment. If you have a CSF leak, please feel free to call our office.