A cerebral spinal fluid or CSF leak occurs once the fluid surrounding the brain escapes through a hole in the skull. This fluid can either seep from the nose or the ear, depending on the site of damage in the skull bone.
What are the indications?
An individual with a CSF leak might have the following:
- Watery, clear drainage from one side of the ear or nose
- Drainage is increased when tilting the head forward or straining
- Hearing loss
- Visual changes
It is important to note that the leaks can be categorized into 2 groups – spontaneous and traumatic. For a spontaneous leak, it occurs without any known cause. As for a traumatic leak, it is usually associated to a history of head injury, tumors or previous surgeries.
How is it diagnosed
The doctor will conduct a history and physical examination. Oftentimes, the doctor might assess the nose using an endoscope. The individual might be instructed to bend forward for a few minutes to check if this aggravates the drainage.
If the drainage can be obtained, it is sent to a laboratory for analysis to confirm if it is cerebral spinal fluid. In some cases, imaging tests such as MRI or CT scan might be requested to assess for any defects in the skull bone.
Management of CSF leak
The treatment can be medical or surgical in nature. The conservative approach is generally suggested initially in cases of spontaneous CSF leak or head injury. The treatment involves 1-2 weeks while under bed rest. The individual is encouraged to avoid sneezing, coughing and heavy lifting. As for straining, it is avoided by providing stool softeners. In some cases, a lumbar drain might be inserted in the lower back to reduce the pressure of the CSF fluid surrounding the site of the leakage and allow healing to take place.
The surgical approach for a CSF leak is used if the conservative approach is not effective. The method can be an outside incision or endoscopic. Throughout the procedure, a graft material is inserted to seal the gap in the skull base. Nasal packing is often placed and later removed after a week.