Cerebrospinal fluid leak (CSF)

Cerebrospinal fluid, or CSF, refers to the clear fluid that lines and protects the brain and spinal cord. This fluid serves many purposes, including cushioning the brain and spinal cord, providing nutrients, and removing toxins. Any tear of the dura, the tissue which lines the brain and spinal cord, can cause a leak of CSF. This can occur following procedures such as lumbar punctures and spinal anesthesia, trauma, surgery, or can occur spontaneously, especially in the setting of connective tissue diseases such as Ehlers-Danlos syndrome. CSF leaks cause a decrease in intracranial pressure, which can result in unrelenting, debilitating headaches.

How do we diagnose a CSF leak?

Magnetic Resonance Imaging (MRI)

Magnetic resonance imaging, or MRI, is a non-invasive tool for identifying CSF leaks. MRI uses a magnetic field to produce highly detailed images of the spine. MRI does not use radiation and is not associated with radiation risks.

Computed Tomography Myelography

Computed tomography, or CT scans, can be used to diagnose CSF leaks. CT scanners use a series of x-rays and advanced computers to create images of the brain and spine. A related technique called CT myelography adds contrast dye injected into the spinal canal to identify the site of a CSF leak.

How do we treat a CSF leak?

Once the site of a CSF leak has been identified, minimally invasive techniques can successfully be used to patch the leak and prevent further symptoms. Most commonly, a sample of the patient’s blood is drawn, processed, and then injected at the site of the leak. This procedure is typically performed under the guidance of CT. Alternatively, a man-made sealant can be injected with the same technique in order to patch the CSF leak.