Spinal Cerebrospinal Fluid (CSF) Leaks

Cerebrospinal fluid can leak out from around the spine due to a hole in the dura, the dense tissue that surrounds the brain and spine. The hole can result from:

• A tear caused by a bone spur
• An abnormal connection that forms with a nearby vein
• A traumatic injury
• Placement of an epidural catheter for childbirth or pain management

The tear and resulting leak of cerebrospinal fluid can cause you to lose the protective cushion of fluid around the brain and spinal cord. Low cerebrospinal fluid pressure leads to chronic headaches and other debilitating symptoms including:

• Severe headaches, especially when upright
• New persistent headaches that occur daily, often starting abruptly
• Double or blurry vision
• Ringing in the ears or hearing loss
• Dizziness

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 fluoroscopic imaging to diagnose and treat CSF leaks and other conditions that affect the brain, spine, head, and neck.

Duke neuroradiologists perform a physical exam and conduct a thorough medical history to obtain more information about your symptoms. The following tests may be performed to check CSF pressure and to confirm a CSF leak along the spine.

MRI of the Brain
Usually one of the first tests performed, a brain MRI can reveal abnormalities that may indicate CSF loss. A contrast dye injected intravenously (via an IV) helps highlight these abnormalities on the scan. In a small percentage of people, additional imaging is needed.

MRI of the Spine
This non-invasive test can identify certain types of spinal CSF leaks that have large amounts of fluid spilling into the spinal canal. Results help guide your doctors on how to perform a myelogram.

CT Myelogram or Dynamic Myelogram
Through a lumbar puncture and with imaging guidance, a contrast dye is injected into your spinal fluid via a tiny needle. Then your entire spine is imaged. The dye helps identify leaking fluid and pinpoint the site of a CSF leak. 

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 treatments may be recommended. Recovery can take several weeks. After your procedure, our team will contact you often to monitor your progress.

Blood Patch
Your own blood or, in some cases, a type of surgical glue is used to create a patch that seals the leak. With CT fluoroscopic guidance, the blood and/or glue is injected adjacent to the tear or potential site of the leak. If the precise location isn’t known, one or more patches may be placed. This procedure is performed after you are given medication to help you relax and to reduce pain.

Surgery
If the leak is caused by the sharp edge of a bone spur rubbing against the dura, a spine surgeon can repair the leak and remove the spur causing the problem. 

Venous Fistula Surgery and Embolization
Sometimes a loss of cerebrospinal fluid occurs due to CSF draining too quickly into the venous system through an abnormal blood vessel connection called a fistula. A neurosurgeon can treat the leak by disconnecting the abnormal vein. 

Another option is embolization of the fistula. For this procedure, an interventional radiologist uses an imaging-guided, minimally invasive technique to navigate a small catheter to the fistula and seal it off using medical glue.

One of the Few Centers That Treats 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 and international leaders in developing techniques to diagnose and treat spinal CSF leaks and in researching spontaneous intracranial hypotension. Experts from other centers in the U.S. and around the world consult Duke for training on these subjects.

Nurse Coordinator to Help Navigate Your Care
Our nurse coordinator becomes your one-stop shop for coordinating referrals, sharing appointment and procedure instructions, and communicating with your doctors. They make your CSF leak treatment journey easier by guiding you through it step by step. And they are available to answer all of your questions along the way.

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

Referral Center
We receive more than 500 referrals to evaluate spinal CSF leaks every year. People have traveled 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.