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Diagnosis & Treatment

Cerebrospinal Fluid (CSF) Leak

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How is a Cerebrospinal Fluid (CSF) Leak Diagnosed?

Diagnosis

At NewYork-Presbyterian, our cerebrospinal fluid leak specialists will diagnose your condition through a physical examination of your joints and an assessment of your symptoms. A combination of imaging tests and blood work may be used to aid in the diagnosis of a CSF leak.

Tests may include:

  • Beta-2 Transferrin testing of rhinorrhea liquid may be used to see if fluid from the nose or ear is from a leak. This is done by testing for the presence of a certain compound called Beta-2 transferrin, which is found in CSF.
  • CT scan, or computed tomography imaging, may be used to view the skull and tissues and identify the location of the CSF leak. CT myelogram, or a CT with a contrast solution, may also be used; during this procedure, contrast dye is injected into the spinal canal to show a clear picture of the head and spine.
  • MRI, or magnetic resonance imaging, may be used to obtain detailed imaging of the spine or head.
  • Cisternogram, which involves injecting radioactive material into the spine, tests the flow rate of CSF in the head and spine.

How is a CSF Leak Treated?

Treatment

There are various CSF leak treatments, based on the type of leak, its size, the location, and what caused the tear. Small CSF leaks can sometimes be treated with rest and fluids and may heal on their own. Larger or continuous spinal fluid leaks may need medication, nonsurgical intervention, or surgery.

CSF leak treatment options include:

Medications

  • Over-the-counter pain relief medications can sometimes be used to relieve spinal fluid leak symptoms, such as a low-grade headache.
  • Antibiotics can treat or prevent infections, such as meningitis.

Nonsurgical options

  • Bed rest and oral fluids may be recommended for small tears. In these cases, lying down to rest and staying hydrated are often the best course of treatment. Your physician may recommend caffeine, which may help relieve headaches and has been shown in clinical studies to increase the amount of CSF in the body.
  • A lumbar epidural blood patch involves injecting blood from the patient’s lower back into the CSF surrounding the spine to patch up the leak.

Surgical options

  • Endoscopic repair may be done for nasal CSF leaks, in which the doctor works through the nostril to patch up the tear.
  • Minimally invasive surgery, called craniotomy, may be performed by a surgeon for tears located in the head, using soft tissue or creating a patch to seal the area.
  • Lumbar draining involves placing a catheter in the lower back to relieve pressure and symptoms.
  • Stitches or tissue graft surgery may be used for CSF leaks located in the ear.

FAQs

FAQs

With a CSF leak, the discharge is clear and very watery, and often only comes out of only one nostril. A nasal CSF leak may worsen when sitting up or lying down.

It is important to see a physician for proper diagnosis, symptom management, and treatment of a CSF leak. An untreated CSF leak may lead to a serious infection called meningitis and other complications.

A small CSF leak may resolve on its own, but only a doctor can evaluate your condition to identify the size, location, and ideal treatment. CSF leaks that are left untreated can cause damage if they lead to dangerous infections, such as meningitis or tension pneumocephalus, a rare but serious complication.

A spinal fluid leak can heal by itself if it is small and mild. It is important to get care from a CSF leak specialist who can help determine the proper course of treatment. Bed rest and hydration with fluids are often recommended for mild leaks.

There are many treatment options for spinal fluid leaks, ranging from nonsurgical options, such as a lumbar epidural blood patch, to minimally invasive surgery. At NewYork-Presbyterian, our spine specialists offer a full range of comprehensive services to fix spinal fluid leaks.

 

This content has been reviewed by the following medical editors.

Ibrahim Hussain, MD

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Trust NewYork-Presbyterian for Cerebrospinal Fluid Leak Treatment

At NewYork-Presbyterian, our dedicated neurosurgeons and spine specialists have expertise and experience in treating and managing cerebrospinal fluid leaks. Get complete care for your symptoms with our personalized surgical and nonsurgical options. Make an appointment with an NewYork-Presbyterian cerebrospinal fluid leak expert today.