A cerebrospinal fluid (CSF) leak occurs when the fluid surrounding the brain leaks and comes in contact with the nose, sinuses or ear. The fluid is typically contained around the brain and spinal cord by a thick covering called the dura. The dura can be damaged by certain surgeries, head injuries and tumors. Symptoms typically include a headache that worsens when you sit up and eases when you lie down; drainage from the nose (CSF rhinorrhea); and, drainage from the ear (CSF otorrhea)

If left untreated, this condition can lead to meningitis, brain infection, stroke and death, therefore, a timely diagnosis and repair is important. Endoscopic advances allow most leaks to be through the nose with small scopes and instruments. CSF leaks from the ear typically require an external incision.

Treatment Options

• Endoscopic CSF leak repair has a success rate of 90-95 percent with
  the initial attempt and carries far less morbidity than an open approach.
  The procedure precisely identifies the location the leak and then small pieces
  of tissue from the nasal lining are placed on the leak site.
  
• Repair of CSF Otorrhea (drainage from the ear):  Controlling drainage from the
  ear still requires traditional surgical incisions. The surgical option depends on the
  location of the leak – the posterior fossa or the middle cranial fossa. A posterior
  fossa incision is frequently performed as an outpatient procedure. A middle cranial
  fossa craniotomy requires 3-4 days in the hospital.

Surgical Risks and Complications
As with any surgical procedure, there are certain risks associated with endoscopic sinus surgery, including:

• Bleeding, scarring and/or infection
• Change in smell or taste
• Injury to the eye (loss of vision, temporary or prolonged double vision and eye tearing)
• Potential for infection spreading to brain resulting in meningitis

Recovery
The typical postoperative stay is two to three days to confirm closure of the leak. If a spinal drain is necessary during surgery, the stay can be longer. If sutures are required, they will be removed 10-14 days after surgery. The repair site can take four to six weeks for complete healing. The patient will be restricted in activities, such as straining and lifting heavy items and nose blowing.

For more detailed, technical information on this issue, please read our Cerebrospinal Fluid Leak patient information sheet.