CSF Leaks and Skull Base Defects

Cerebral Spinal Fluid (CSF) is the fluid that bathes the brain and spinal cord. Usually it is contained in one area within the skull and down the spine, but sometimes a tiny hole can develop between the brain cavity and the sinuses and nasal cavity. This is considered a CSF leak.

Symptoms of CSF leaks include headaches accompanied by a clear, intermittent or constant nasal drainage that will increase or occur more frequently when bending over or straining, usually dripping out of one side of the nose, rather than out of both sides. Often the fluid also drips down the back of the throat.

The main concern is that when a CSF leak occurs, the leak allows a direct communication between the nasal cavity and the brain. Therefore, bacteria and viruses have a direct pathway to the brain. Meningitis, a serious infection to the lining of the brain, can result when a CSF leak occurs. Symptoms of meningitis include severe headaches, fever, nausea, stiff neck, and an altered mental state. If a CSF leak is suspected, the patient should see a physician as soon as possible. If symptoms of meningitis are suspected, the patient should go to the emergency room.

CSF leaks are diagnosed by physical and endoscopic exam and by collection and analysis of the fluid. Sometimes CT or MRI scans are ordered to aid in diagnosis. If a CSF leak is identified, it must be surgically repaired.

Surgical repair of a CSF leak is commonly performed through the nasal cavity endoscopically, without any external incisions. Depending on the size and severity of the leak, sometimes neurosurgeons are called upon to help in surgery.

The surgery is done under general anesthesia, with at least one overnight stay. This surgery is similar in approach to endoscopic sinus surgery, but technically more difficult. The leak is patched with either synthetic material of material from within the nasal cavity. This is used to permanently close the leak.

There is usually a six-week recovery period after the surgery during which patients must limit their physical activities to prevent recurrence of the leak.

For more information on CSF leaks and skull base defects, please speak with your physician.