Cranial Cerebrospinal Fluid (CSF) Leaks

Cerebrospinal fluid (CSF) is a watery fluid that protects, nourishes, and removes waste from the brain and spinal cord. When an area of the skull is damaged, becomes thin, or cracks, the dura (the covering of the brain and spine) is exposed and can easily tear. This can be caused by a traumatic injury, tumor, infection, surgery, or intracranial hypertension.

Intracranial hypertension is similar to high blood pressure, but in the brain. CSF under pressure can wear down the skull, making it weak and thin. Intracranial hypertension can be primary, meaning there is no certain cause, or secondary to another problem, such as a brain bleed.

Cranial CSF Leak Signs
The most common signs for cranial CSF leaks include chronic headaches and watery discharge from the nose or ear, especially on one side. Without treatment, CSF leaks can lead to dangerous intracranial infections such as meningitis or cerebritis, pneumocephalus (air in the brain and skull), and headaches.

Surgery is often the best treatment option for cranial CSF leaks. Surgical approaches are tailored to the exact location of the leak. Once surgeons reach the leak site, they repair the hole by plugging it with tissue or fat. 

Anterior Approach
For leaks on the front of the skull (anterior), surgeons may access and repair the leak through the nostrils using a minimally invasive, endoscopic approach. This technique speeds recovery, leaves no visible scars, and requires only a couple of nights’ stay in the hospital.

Lateral Approach
For leaks on the side of the skull (lateral), surgeons may access and repair the leak through incisions behind the ear, which leave less visible scarring. You’ll need to stay in the hospital for three or four nights.

Posterior and Other Approaches
For leaks on the back of the skull (posterior) or that are difficult to access through the nose or behind the ear, surgeons may perform a traditional craniotomy, which requires a larger opening in the skull. This requires a longer hospital stay, usually three to seven days.

After Surgery
You’ll be asked to return for follow-up visits one week after surgery and several more times at increasing intervals. You should begin to find relief from pain and other symptoms after seven to ten days.

CT/MRI Fusion Technique
CT/MRI fusion is a navigation system, similar to a GPS, used during CSF leak surgery. The technique combines CT scans (which are ideal for displaying bony anatomy) and MRI scans (which are ideal for displaying softer tissues and fluids) and uses reference points to identify important neurological structures. This can optimize your surgeon's accuracy and help them avoid damage to surrounding tissue.

Vast Experience with 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 symptoms. Our advanced training, experience, and large number of cases contribute to our excellent results.  

A Team of Specialists
Our team of sinus specialists, otologists, neurotologists, neuroradiologists, neurosurgeons, neurologists, neuro-ophthalmologists, and others work together to coordinate your treatment. Their combined expertise ensures you experience a better outcome.  

Patient Navigators for Coordination of Care
Our patient navigators become your one-stop shop for scheduling appointments, coordinating your visits, communicating your test results, and planning surgery. They make your treatment journey easier by guiding you through it step by step. They are more than willing to answer all of your questions along the way.