Guest post by Satish Govindaraj, MD, Chief of the Division of Rhinology and Sinus Disorders, Mount Sinai Health System
Chances are likely that you may never have a cerebrospinal fluid (CSF) leak, but this condition affects approximately 5 in 100,000 people each year, and for many of them, it goes undiagnosed or may be misdiagnosed as a headache disorder or sinusitis. You may know someone or have a family member who is affected by a CSF leak, so it’s helpful to get informed in case you hear an individual say, “I’ve had clear fluid coming out of one side of my nose, and I don’t believe it’s a cold.”
A CSF leak occurs when the fluid that surrounds the brain and spinal cord makes its way out of these locations and starts to drain into the nose, ear, or soft tissue around the spinal cord. This condition can be serious, if it leads to chronic headaches or a severe infection, such as meningitis. Below are some of the most frequently asked questions patients ask me.
What Causes CSF Leaks?
CSF leaks may be due to traumatic or atraumatic reasons. Trauma to the head that causes a fracture may create a tear in the lining of the brain through which CSF leakage may occur. CSF leaks may also be a result of surgical trauma in the base of the skull. Most times these are expected leaks during a tumor removal; however, less often a CSF leak may be a complication of surgery in this area. The atraumatic leak is known as a spontaneous leak and tends to occur in patients who have an elevation in their intracranial pressure. This is a similar concept to high blood pressure. The constant high pressure around the brain causes CSF to leak though weak areas in the bone that communicates with the ear and nasal cavity.
What Are the Symptoms of CSF Leaks?
The classic presentation of CSF leaks is the expression of clear, watery drainage from the nose or fluid behind the eardrum. Rarely, certain patients may present with severe headaches when sitting up. The drainage from the nose may have a salty taste, but this is not always the case. In addition patients with spontaneous leaks may have associated complaints of pulsatile tinnitus, headaches, or blurry vision.
Why is it Critical to Repair a CSF Leak?
CSF leaks should be repaired because in the setting of communication with the nose and ear, the risk of ascending infection such as meningitis is present. This infection poses a risk of permanent damage to the brain.
What is Different at Mount Sinai?
The diagnostic algorithm at Mount Sinai for CSF leaks avoids the need for an invasive lumbar puncture, which is a common method of leak localization. The Departments of Otolaryngology, Neurosurgery, and Radiology have developed a CT/MRI Fusion technique that permits a high resolution CT scan and MRI to be fused in such a way that a patient’s CSF leak may be localized with high accuracy.
Almost all CSF leaks that drain through the nose can be sealed with a minimally invasive endoscopic surgical technique. Tissue used locally from within the nose is used to seal the leak. Patients with spontaneous leaks are managed medically in our Skull Base Surgery Center after the surgery to stabilize their intracranial pressure in order to avoid the development of future leaks.
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Satish Govindaraj, MD, is the Chief of the Division of Rhinology and Skull Base Surgery at the Mount Sinai Health System. To make an appointment with Dr. Govindaraj, call 212-241-9410 or visit www.mountsinai.org/ent and complete the Make an Appointment form.