The human brain is cushioned by clear, colorless liquid called cerebrospinal fluid (CSF). Flowing through the ventricles in the brain, this important fluid protects the cerebral tissue from mechanical trauma and infections.
Defects in the skull base, which lies beneath the brain at the roof of the nose, can lead to tears in the tissue surrounding the brain, called the dura. These dura tears can allow CSF to leak into the nose. Nasal CSF leaks can occur spontaneously or as a result of trauma or previous sinonasal surgery. This is a very serious condition, and these tears must be repaired in order to prevent meningitis, an infection of the brain tissues.
CSF Leaks: What You Need to Know
Symptoms of CSF leaks include a constant dripping of clear fluid from the nose, severe headaches and meningitis.
Leaks of CSF are usually caused by blunt trauma to the head and/or ears or prior sinonasal surgery. However, spontaneous CSF leaks can occur in patients with elevated intracranial pressure.
Diagnosing CSF leaks usually involves a physical exam, nasal endoscopy, CT or MRI scan and a fluid collection.
When CSF leaks occur after head trauma, they may sometimes heal with bed rest and medical therapy. However, CSF leaks that occur spontaneously or are of long duration need to be repaired surgically.
Whenever possible, the preferred surgical repair of CSF leaks is performed endoscopically entirely through the nose. In some situations, the repair cannot be done endoscopically and must be performed through the skull with a neurosurgical approach.