Primarily produced by the choroid plexus in the brain, cerebrospinal fluid (CSF) is a clear, watery fluid that constantly flows between the brain and spinal cord. This continual flow of about 125 to 150 milliliters of CSF transports hormones and nutrients to the brain. If a leak occurs, it may result in potentially serious and disruptive symptoms. CSF leaks are rare, but it’s still important to understand what to look for and what may cause a leak to occur.
What Causes a Cerebrospinal Fluid Leak?
CSF leaks in the area where fluid normally travels from the brain to the spinal cord can be either spontaneous (occurring without any specific reason) or traumatic in nature. The main area where the fluid flows is within the thoracic (upper and middle back) spine. Traumatic CSF leaks may be caused by a blow to the head or other traumatic injury. A tumor may also cause a leak to develop. Some other possible causes and contributing factors may include:
- Failure to properly secure a hole made during surgery to drain excess CSF
- Spinal bone growths
- Injuries from whiplash
What Happens When There Is a CSF Leak?
A “leak” refers to a small hole that develops where the fluid is traveling, causing cerebral spinal fluid to drain elsewhere. As a result of a leak, there is a shortage of fluid. If levels of this fluid are too low, symptoms may include:
- Headaches that occur while standing
- Blurred/double vision or other changes in vision
- Hearing issues and/or ringing in the ear
- Numbness in the face
- Tingling sensations in one or both arms
How Is a Leak Diagnosed?
Since symptoms can suggest many potential issues, diagnosis is often a trial and error process based on an elimination of other possible causes. Diagnosis also includes a physical exam. An optical tube with a camera attached (endoscope) may be used to examine the nose. Detection may also involve:
- Imaging studies (CT scan, MRI)
- An attempt to collect fluid by having the patient lean forward and testing the sample to confirm that it is CSF
- The injection of a dye into the spinal canal to determine the location of the leak (lumbar puncture)
What Are Possible Treatment Options for CSF Leaks?
Initial treatment often includes rest and drinking plenty of water to stay hydrated, which encourages natural healing of the hole. Steroids are sometimes recommended to further facilitate healing. Surgical intervention may include an injection of the patient’s own blood into the epidural space (blood patch) to restore fluid pressure. If this isn’t effective, graft material may be used to seal the leak. A lumbar drain is sometimes placed in the lower back to reduce pressure around the area of the CSF leak. Though spinal fusion surgery is not necessary in this instance, there are also various alternatives to spinal fusion. Beverly Hills patients should see a spine specialist as soon as possible if they are experiencing any of the symptoms of a CSF leak.
Patients are typically instructed to avoid excessive straining, including forceful coughing and sneezing, for 1 to 2 weeks during attempts to allow natural healing to correct the problem. There is no effective way to prevent a CSF leak, although it may help to take steps to ease trauma around the upper spine and neck as much as possible when engaging in activities that place stress on the base of the skull or upper spine.
At The Spine Institute Center for Spinal Restoration, we specialize in a wide array of procedures that can help patients find relief for their spinal conditions. These procedures range from spinal cord stimulation to ACDF surgery. Beverly Hills residents should call 310-828-7757 today to schedule an appointment.