Cerebrospinal Fluid Leak Treatments

Cerebrospinal Fluid Leak Treatments

Relief from Chronic Headaches Due to CSF Leaks

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Severe headaches, especially when you're upright; chronic migraines that don’t respond to medication; and new persistent headaches may signal a cerebrospinal fluid (CSF) leak.

While CSF leaks are often misdiagnosed, Duke neuroradiologists are among the few experts in the country skilled at finding and repairing CSF leaks. Our comprehensive evaluation often identifies CSF leaks in people whose symptoms have not responded to conventional treatment. Our experience treating CSF leaks makes it possible for people to obtain relief from symptoms they’ve lived with for years, sometimes even decades.

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What Is a CSF Leak?

Cerebrospinal fluid can leak through a tear in the dura, the dense tissue that surrounds the brain and spine. The tear can result from:

  • A traumatic injury
  • Placement of an epidural catheter for childbirth or pain management
  • Rubbing against a spinal disc or arthritic facet joint

Often, there is no known cause.

The tear and resulting leak of cerebrospinal fluid can cause lower-than-normal pressure in the protective cushion of fluid around the brain and spinal cord. This is called intracranial hypotension. The low pressure leads to chronic headaches and other debilitating symptoms including:

  • Severe headaches, especially when upright
  • New persistent headaches that occur daily
  • Double or blurry vision
  • Ringing in the ears or hearing loss
  • Dizziness
  • Swallowing difficulties
  • Facial pain

If You Experience These Symptoms
Because these symptoms may indicate a variety of neurological concerns, CSF leaks are often misdiagnosed. If you are experiencing these symptoms and have not found relief through standard medical treatments, consider evaluation for a spinal CSF leak.

Seek Care from a Neuroradiologist
Duke neuroradiologists specialize in using high-resolution CT, MRI, and CT fluoroscopic imaging to diagnose and treat CSF leaks and other conditions that affect the brain, spine, head, and neck.

Our Locations
Duke Health offers locations throughout the Triangle. Find one near you.

Tests for CSF Leaks

Duke neuroradiologists perform a physical evaluation and conduct a thorough medical history to obtain more information about your symptoms. One or more of the following tests may be performed to check CSF pressure and to confirm a CSF leak along the spine or base of the skull.

CT Myelogram

A contrast dye is injected into your spinal canal via a lumbar puncture with a tiny needle under CT fluoroscopic guidance. Images are acquired and analyzed to look for the site (or potential site) of a CSF leak.

Magnetic Resonance (MR) Myelography

This can be performed without contrast in order to look for signs of a leak without any intervention.

MR myelography can also be performed to find a leak that has not been detected by CT. This may require the injection of MR contrast into the spinal sac before imaging.

MRI of the Brain

This can reveal brain abnormalities that may indicate CSF fluid loss. This should be performed with and without contrast and should include sagittal images of the brain. A small percentage of people with CSF leaks will have a normal MRI of the brain, so additional imaging is often needed.

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Treatment Options

When conservative treatments such as bed rest and hydration don’t relieve symptoms, a procedure is often required to repair a CSF leak. Depending on the cause of the leak, one of these customized treatment options may be recommended. Recovery can take several weeks.

Our personalized follow-up care includes regular phone calls from your doctor or follow-up appointments to monitor your progress.

Blood Patch

Your own blood or, in some cases, a type of glue is used to create a patch that seals the leak. The blood and/or glue is injected adjacent to the tear or potential site of the leak under CT fluoroscopic guidance. If the precise location isn’t known, one or more patches may be placed. This procedure is performed while you are under moderate sedation.

Disc Surgery

If the leak is caused by the sharp edge of a spinal disc rubbing against the dura, a surgeon can stop the friction and repair the leak by shaving off the sharp edge and wrapping the dura with collagen fiber.

Venous Fistula Surgery

Sometimes a loss of cerebrospinal fluid occurs due to CSF draining too quickly into the venous system. To regulate the loss of fluid, a neurosurgeon can wrap or clip the vein at a nerve root and remove adjacent veins.

Consistently Ranked Among the Nation’s Best Hospitals
In addition, Duke University Hospital is proud to be named the best hospital in North Carolina, and nationally ranked in 10 adult and 9 pediatric specialties by U.S. News & World Report for 2019–2020.

Why Choose Duke

One of the Few Centers that Treat CSF Leaks
Duke is one of the few centers in the country with the expertise to diagnose and treat CSF leaks that cause chronic headaches and other neurological symptoms. Our advanced training, experience, and large number of procedures contribute to our excellent results.  

Unique Expertise
Since 2006, Duke neuroradiologists have been national leaders in developing techniques to diagnose and treat spinal CSF leaks. Experts from other centers in the U.S. and around the world consult Duke for training in diagnosing and treating these leaks.

A Team of Specialists
Our neuroradiologists collaborate with neurologists, neurosurgeons, and orthopaedic surgeons to coordinate the best treatment for your condition.

Referral Center
We see 400 to 500 people with spinal CSF leaks every year. People travel to Duke from across the U.S., Canada, Europe, Asia, Africa, Australia, and New Zealand in search of an accurate diagnosis and treatment for CSF leaks.

Reviewed: 08/09/2018