A cerebrospinal fluid leak is a serious condition that warrants proper medical evaluation. At Houston Sinus Surgery at the Yeung Institute, you will find compassionate, expert care. With over 20 years of experience as an ear, nose, and throat doctor in Houston, Dr. Cecil Yeung is dedicated to diagnosing and treating patients suffering from a CSF leak. His extensive experience has proven that most of these skull base defects can be corrected endoscopically on an outpatient basis, rather than requiring a lengthy, open skull surgery. If you are experiencing any of the symptoms of a CSF leak, contact our office right away to schedule a consultation with Dr. Yeung.
What is a cerebrospinal fluid (CSF) leak?
Cerebrospinal fluid (CSF) is the fluid that surrounds the brain, which is contained within a lining called the dura. The dura is a tough, inflexible tissue. Despite its toughness, it can suffer from a tear that causes a CSF leak. The structures within the brain cavity are separated from the sinuses by bone. When there is a hole in the dura surrounding the brain in addition to damage to the bone around the sinuses, CSF can leak directly into the sinuses. The leak can either drain through the ear or the nose, depending on where the dura is damaged.
What causes a CSF leak?
A CSF leak involves both a break in the dura surrounding the brain, as well as a break in the bone surrounding the sinuses. This is most often caused by a traumatic injury, but it may result from a number of possible causes including:
- Head injury
- An accident involving the brain, sinus or spine
- A complication from sinus or brain surgery
- A complication from removing a tumor within the sinuses
- Placement of tubes for epidural anesthesia or pain medications and/or spinal tap
- Increased pressure on the cerebrospinal fluid that erodes the bone separating the brain and sinuses
In some rare cases, high CSF pressure might occur without any obvious cause, which leads to what is known as a spontaneous leak.
What are the symptoms of a CSF leak?
When a leak occurs, your CSF pressure drops around the brain and spinal cord. This is a very serious condition that may lead to the following symptoms:
- Clear drainage from the nose or into the back of the throat
- Nasal congestion that does not improve with medications for a runny nose
- Clear, watery fluid that drains out of one side of the nose or one ear
- Salty tasting fluid that drains into the throat
- Drainage that increases when tilting the head forward or straining
- Headache that may be worse when you sit up and improve when you lie down
- Light sensitivity
- Neck stiffness
- Vision changes
- Hearing loss
How is a CSF leak treated?
A variety of tests with an experienced Houston ENT will be performed in order to diagnose a CSF leak. Tests may include a CT scan of the head with contrast dye, an MRI of the head and/or radioisotope test of the CSF to track the leakage. Diagnosis will also involve a thorough medical history, including taking a history of any injury, surgery, or lumbar puncture.
In some cases, a CSF leak may heal on its own with no lasting symptoms. In fact, a CSF leak that results from trauma to the head may be managed with placement of a lumbar drain and bed rest. In other cases, a CSF leak may need to be surgically repaired. A surgical repair for a CSF leak in Houston is typically performed endoscopically through the nose on an outpatient basis. It involves inserting a small camera called an endoscope through the nostrils, which allows Dr. Yeung to visualize the problem area up close and make the necessary repairs with great precision. Although this type of surgery generally does not involve any incisions on the face, in rare situations where the defect is within the frontal sinuses above the eyes, a small incision may be necessary. Proper closure of a CSF leak is important to prevent the life-threatening complication of meningitis.