Cerebrospinal fluid (CSF) leaks London

Overview

Cerebrospinal fluid (CSF) leaks

Cerebrospinal fluid (CSF) is the clear, watery fluid that surrounds and protects the brain. A CSF leak happens when there is a small hole or weakness in the bone at the base of the skull, allowing this fluid to escape into the nose or ear.

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What are the symptoms of a CSF leak?

Patients may notice a clear, watery drip (often worse when bending forward), headaches that improve when lying down, a salty taste in the mouth, hearing changes or a feeling of pressure in the head. Alongside these discomforts and annoying symptoms for patients, CSF leaks can be a very serious problem indeed. That’s because they create a direct pathway between the outside world and the space around the brain, increasing the risk of infections. CSF leaks can even lead to meningitis in some cases if they are left untreated.

Can a CSF leak affect brain function or cognition?

A CSF leak doesn’t typically harm the brain tissue directly, but it can affect how the brain works because the fluid that normally cushions and supports the brain is reduced. When that protective fluid is low, the brain can “sag” slightly inside the skull, which can lead to difficulty concentrating, brain fog, memory problems, slowed thinking and/or fatigue.

What causes a CSF leak?

For many patients the exact cause of their CSF leak may be unknown, but these are the three most common reasons for developing a CSF leak:

Traumatic CSF leak – this is a leak caused by a direct injury to the head or face, such as a car accident, sports injury, fall or assault. The force of the impact can crack the thin bones at the base of the skull, creating a small opening that allows the fluid around the brain to escape (either into the nose, ear or down the back of the throat).

Recurrent CSF leaks after prior surgery – these are leaks that return after previous sinus, ear or skull base surgery. It may be because the original defect has reopened or new pressure has developed, or as a result of the surgery itself

Spontaneous CSF leaks associated with idiopathic intracranial hypertension – these are leaks that occur without trauma or surgery, often due to raised pressure inside the skull pushing through naturally thin areas of bone.

Where is the CSF leak coming from?

CSF leaks can occur in different parts of the skull base and are categorised accordingly:

Anterior skull base CSF leaks are leaks from the thin bone between the brain and the nose, often causing clear nasal drainage. There are three main areas they occur from:
- Cribriform – the thin bone at the roof of the nose
- Ethmoid – the bone between the eyes
- Sphenoid – the deep sinus behind the nose
Temporal bone CSF leaks – leaks from the bone around the ear, which may cause fluid to drain from the ear or affect hearing

How do CSF leaks link to tumours in the skull, head and neck?

CSF leaks are closely linked to skull base tumours because tumours can erode the bone, surgery to remove a tumour can leave a small defect, or increased pressure from a tumour can force fluid through weak areas. Even though the opening may be tiny, the consequences can be significant.

Why choose the Skull Base Specialists?

Repairing a CSF leak safely requires surgeons who understand the delicate anatomy of the skull base, the nerves around the brain and the pathways of the sinuses and inner ear. Skull Base Specialists use advanced endoscopic and microsurgical techniques to close the leak, protect the brain and address any underlying tumour or pressure problem to prevent the leak from returning.

Everyone knew me for having a constant supply of tissues to blow my constantly running nose with. I have had a runny nose for a very long time, probably about eight years and was told I had a cold, hay fever, allergies – no doctors took me seriously. But the constant nose blowing was abrasive and the skin was getting sore and damaged, so I decided to see a Skull Base Specialist. Mr Mark Ferguson was absolutely brilliant, he’s very down to earth and approachable. He put me at ease from the first appointment. He conducted a naso-endoscopy and was able to rule out cancer, but he did suspect that something was happening inside my nose and asked me capture the fluid in a specimen jar. The results showed the fluid was brain fluid which was leaking internally. Mr Mark Ferguson was very reassuring and helped me to understand this wasn’t as worrying as it sounded and he would help me solve the issue. I had four brain scans – CTs and MRIs – to try to find the hole. On the day of my surgery I had dye injected into my spine to guide Mr Ferguson on where the leak was. A skin graft from my leg was used to patch the hole. The surgery was a technical success. Six weeks later and my runny nose is no more and I can ditch the packet of tissues. I am so fortunate that I was referred to Mr Mark Ferguson and he spotted my unusual problem.

Ray 71, Barnes

Traumatic CSF leak

Overview