Cerebrospinal Fluid Conditions
The term cerebrospinal fluid condition describes the condition that occurs when the clear fluid that supports the brain and spinal cord escapes into other parts of the body. For most instances, treatment consists simply of bed rest, hydration, and possibly a lumbar drain. However, sometimes surgical intervention—such as endoscopic neurosurgery through the nose, or open surgery using a craniotomy—is needed.
The clear fluid that escapes is called cerebrospinal fluid (CSF), and it has a vital role in the health of the central nervous system. Bathing the brain and spinal cord, CSF cushions these organs from everyday movement, provides nourishment, and washes away cellular waste products. The CSF is confined within the central nervous system by a protective membrane called the dura mater.
If the dura mater is torn, CSF can leak out of the central nervous system. The focus of this page is CSF that escapes the brain.
Symptoms commonly include:
- Headaches that are more severe when sitting upright and are alleviated by lying down with the head lower than the chest
- Horizontal diplopia
- Blurring of vision
- Change in hearing (hearing loss likely results from lowering of cerebrospinal fluid pressure, which lowers inner ear pressure)
- Facial numbness
- Tingling of the arms
A combination of diagnostic tests is typically used to provide a diagnosis and also detect the location of the cerebrospinal fluid (CSF) condition.
Possible diagnostic tests include:
- Computed tomography (CT) scan of the head to view leak location and produce detailed images of skull anatomy and tissue. Usually, contrast enhancement is administered during the scan for better visualization.
- CT myelogram, a test in which a contrast enhancement is injected into the spinal canal and then the structures in the head and spine are imaged in great detail using CT scanning.
- Head or spine magnetic resonance imaging (MRI) to visualize tissue, blood vessels and other structures and also detect location of the leak. This study is usually conducted with contrast enhancement to yield highly detailed images.
- Cisternogram, a test that requires the injection of radioactive material into the spinal canal in order to detect abnormal CSF flow in the central nervous system.
- Collection and testing of clear fluid that drains from the nose with beta-trace protein assay to determine whether the fluid is CSF.
A cerebrospinal fluid (CSF) condition may be caused by:
- Accidental over-draining of a CSF shunt, as may occur during treatment for hydrocephalus
- Inadequate production or too-rapid absorption of CSF
- A tear in the dura mater surrounding the brain and spinal cord
The dura mater can become torn, causing CSF to leak out, for one of several reasons. Most often, the reason is head trauma, high-pressure hydrocephalus or brain surgery. Spontaneous leaks are rare.
At Columbia, our neurosurgeons use the most sophisticated surgical techniques to treat cerebrospinal fluid (CSF) conditions, providing the best possible prognosis.
Our neurosurgeons take a conservative, noninvasive treatment approach first because most CSF conditions heal on their own without surgical intervention.
Patients are simply instructed to get a week or two of bed rest and drink plenty of fluids, particularly caffeinated beverages because caffeine stimulates the production of CSF. Medications such as pain relievers, steroids, or antibiotics may also be prescribed. If intracranial pressure is high, patients may have a lumbar drain placed in the lumbar area of the spine, allowing small amounts of CSF to drip out and preventing further injury to any damaged tissues.
If the condition does not heal without further intervention, surgery to repair the leak is necessary. Many patients are good candidates for endoscopic neurosurgery through the nose or mouth, which is a minimally invasive technique. Using an endoscope, the surgeon repairs the CSF leak without making any visible incisions.
Sometimes traditional open surgery is best for the patient and therefore performed instead. This approach involves performing a craniotomy, a procedure in which a section of skull is temporarily removed, so that the neurosurgeon can access the brain and repair the leak.
Although surgery is rarely needed, a proper diagnosis and expert management of nonsurgical treatment are essential. Complications, such as meningitis, can arise if the condition is inadequately addressed.